In another recent study of postmenopausal women, 17.2% of patients had their diagnosis upgraded to severe osteoporosis owing to VFs diagnosed on VFA [96]. A meta-analysis based on VFA-detected VFs reported that among women who had prevalent VFs, up to 43% had low BMD (osteopenia), and up to 32% had normal bone density [76]. Detection of unknown VFs influences initiating therapy in asymptomatic patients as well as guides therapeutic decisions in treated patients whose BMD may have remained stable or shown improvement on DXA [97]. Osteoporosis and Bone Mineral Density QCT QCT is regarded as a secondary or adjunct tool to DXA. It may be considered as a primary modality in cases in which there is severe degenerative disease of the spine or significant scoliosis (see Variant 6) and when it is desirable to have higher spatial resolution to optimize bone detail. QUS There is insufficient evidence to support the use of QUS to image the spine. Radiography Appendicular Skeleton There is insufficient evidence to support the use of appendicular radiography to image the spine. Radiography Axial Skeleton Lateral radiographs of the spine may be considered when VFA is not diagnostic or when images cannot be adequately derived. Additionally, radiographs of the spine may be considered as an alternative to VFA in patients who have low BMD and risk factors for developing VFs [17]. The benefit of radiography over VFA is superior spatial resolution. The sharp delineation of the end plates and cortical margins affirms confident detection of subtle Genant grade 1 fractures [98]. When reporting the severity of a vertebral body defect, the semiquantitative methodology by Genant should be used [78]. SXA There is insufficient evidence to support the use of SXA to image the spine. TBS TBS is regarded as an adjunct tool to DXA. TBS may be useful in a small population in which there is a need to look at marginal changes beyond BMD.
Osteoporosis and Bone Mineral Density. In another recent study of postmenopausal women, 17.2% of patients had their diagnosis upgraded to severe osteoporosis owing to VFs diagnosed on VFA [96]. A meta-analysis based on VFA-detected VFs reported that among women who had prevalent VFs, up to 43% had low BMD (osteopenia), and up to 32% had normal bone density [76]. Detection of unknown VFs influences initiating therapy in asymptomatic patients as well as guides therapeutic decisions in treated patients whose BMD may have remained stable or shown improvement on DXA [97]. Osteoporosis and Bone Mineral Density QCT QCT is regarded as a secondary or adjunct tool to DXA. It may be considered as a primary modality in cases in which there is severe degenerative disease of the spine or significant scoliosis (see Variant 6) and when it is desirable to have higher spatial resolution to optimize bone detail. QUS There is insufficient evidence to support the use of QUS to image the spine. Radiography Appendicular Skeleton There is insufficient evidence to support the use of appendicular radiography to image the spine. Radiography Axial Skeleton Lateral radiographs of the spine may be considered when VFA is not diagnostic or when images cannot be adequately derived. Additionally, radiographs of the spine may be considered as an alternative to VFA in patients who have low BMD and risk factors for developing VFs [17]. The benefit of radiography over VFA is superior spatial resolution. The sharp delineation of the end plates and cortical margins affirms confident detection of subtle Genant grade 1 fractures [98]. When reporting the severity of a vertebral body defect, the semiquantitative methodology by Genant should be used [78]. SXA There is insufficient evidence to support the use of SXA to image the spine. TBS TBS is regarded as an adjunct tool to DXA. TBS may be useful in a small population in which there is a need to look at marginal changes beyond BMD.