Combined Vertebral Fracture Assessment and Bone Mineral Density Measurement: A Patient-friendly New Tool with an Important Impact on the Canadian Risk Fracture Classification

Purpose: Vertebral fractures often go unnoticed, while they constitute a significant risk factor for new fractures, independent of the bone density. Vertebral Fracture Assessment (VFA) is a new feature on DXA bone densitometry equipment. Our purpose was to determine the added value of VFA and its impact on the Canadian fracture risk classification using data from a Dutch academic cohort. Methods: All 958 consecutive patients (64% female, mean age 53 [20-94], mean weight 75 kg [32-150]) who underwent BMD measurement at the University Medical Center Groningen, The Netherlands also underwent VFA in the same session. Results: The prevalence of vertebral fractures was 26%. In 68% of these patients this fracture was unknown. The severity was mild (20%-25% height loss) in 43%, moderate (25%-35%) in 44% and severe (>35% height loss) in 13%. Even after excluding mild fractures, the prevalence of vertebral fractures was 17%. In the 28% with normal BMD the vertebral fracture prevalence was still 18%, in the 43% with osteopenia 23%, and in the 29% with osteoporosis 36%. The Canadian risk classification was low fracture risk in 68%, moderate in 19%, and high in 13%. Adding VFA altered the classification in 20% of the patients, to become 54%, 27%, and 19%, respectively. Conclusions: VFA added to BMD is a patient friendly diagnostic tool with a high diagnostic yield, as it detected unknown vertebral fractures and altered diagnostic classification in approximately I out of every 5 patients. These results suggest that BMD plus VFA may become the new standard in osteoporosis testing.