This procedure is complementary to DXA; the image is obtained during the DXA session and represents a point-of-care service. A semiquantitative visual method used for diagnosis characterizes the morphology based on shape (wedge, concave, or crush) and location (anterior, posterior, and/or middle) and the total number of involved vertebrae [78,79]. In general, grade 2 fractures (moderate or 26%-40% reduction) and grade 3 fractures (severe or >40% reduction) are more predictive of future fractures than grade 1 fractures (mild or 20%-25% reduction), which have a greater overlap with nonfracture deformities [80]. A solitary, asymptomatic grade 1 fracture is likely to be minimal to no clinical significance, whereas a grade 3 fracture is an important predictor of fracture risk not only in the spine but also in nonvertebral sites [81]. It is estimated that two-thirds of radiographically evident VFs are not recognized clinically and are incidentally detected [82]. Numerous epidemiologic studies have provided the incidence and prevalence of VFs in different populations [83-85]. The risk for developing a VF rises substantially in women after >70 years of age and in men >80 years of age [86-88]. In patients with chronic exposure to glucocorticoid medication, the prevalence of VF is >50% in those >70 years of age, approximately 17% in patients treated for autoimmune disease, and 22% in patients with Crohn disease [89-91]. The incidence is 2 to 2.5 times higher in women than in men [77]. The utility of VFA is identifying patients who would not otherwise qualify for treatment under the guidelines of the NOF, which are based solely on BMD measurements. Multiple studies have demonstrated populations of patients who were reclassified because of detection of VFs [92-95]. A study in the Netherlands demonstrated that 60% of patients with a fracture on VFA were in the nonosteoporotic range, and of these, 74% were previously unknown to have fractures [92].
Osteoporosis and Bone Mineral Density. This procedure is complementary to DXA; the image is obtained during the DXA session and represents a point-of-care service. A semiquantitative visual method used for diagnosis characterizes the morphology based on shape (wedge, concave, or crush) and location (anterior, posterior, and/or middle) and the total number of involved vertebrae [78,79]. In general, grade 2 fractures (moderate or 26%-40% reduction) and grade 3 fractures (severe or >40% reduction) are more predictive of future fractures than grade 1 fractures (mild or 20%-25% reduction), which have a greater overlap with nonfracture deformities [80]. A solitary, asymptomatic grade 1 fracture is likely to be minimal to no clinical significance, whereas a grade 3 fracture is an important predictor of fracture risk not only in the spine but also in nonvertebral sites [81]. It is estimated that two-thirds of radiographically evident VFs are not recognized clinically and are incidentally detected [82]. Numerous epidemiologic studies have provided the incidence and prevalence of VFs in different populations [83-85]. The risk for developing a VF rises substantially in women after >70 years of age and in men >80 years of age [86-88]. In patients with chronic exposure to glucocorticoid medication, the prevalence of VF is >50% in those >70 years of age, approximately 17% in patients treated for autoimmune disease, and 22% in patients with Crohn disease [89-91]. The incidence is 2 to 2.5 times higher in women than in men [77]. The utility of VFA is identifying patients who would not otherwise qualify for treatment under the guidelines of the NOF, which are based solely on BMD measurements. Multiple studies have demonstrated populations of patients who were reclassified because of detection of VFs [92-95]. A study in the Netherlands demonstrated that 60% of patients with a fracture on VFA were in the nonosteoporotic range, and of these, 74% were previously unknown to have fractures [92].