Skip to main content

Advertisement

SpringerLink
Log in

Bone Densitometry and Vertebral Fracture Assessment

  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Measurement of bone mineral density (BMD) is used to diagnose osteoporosis, assess fracture risk, and monitor response to therapy. Of the different methods for measuring BMD, dual-energy X-ray absorptiometry (DXA) is the only technology for classifying BMD according to criteria established by the World Health Organization (WHO) and the only technology that is validated for BMD input with the WHO fracture risk assessment algorithm, FRAX. Vertebral fracture assessment (VFA) by DXA provides an image of the thoracic and lumbar spine for the purpose of detecting vertebral fracture deformities. Identification of a previously unrecognized vertebral fracture may change diagnostic classification, assessment of fracture risk, and treatment decisions. In comparison with standard radiographs of the spine, the correlation for detecting moderate and severe vertebral fractures is good, with a smaller dose of ionizing irradiation, greater patient convenience, and lower cost. Optimal performance of DXA and VFA requires training and adherence to quality standards.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

FIT:

Fracture Intervention Trial

MORE:

MultipleOutcomes of Raloxifene Evaluation

VERT-MN:

Vertebral Efficacy With Risedronate Therapy Multinational

VERT-NA:

Vertebral EfficacyWith Risedronate Therapy North American

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy: Osteoporosis prevention, diagnosis, and therapy. JAMA 2001, 285:785–795.

    Article  Google Scholar 

  2. • Kanis JA, on behalf of the World Health Organization Scientific Group: Assessment of Osteoporosis at the Primary Health-Care Level. Technical Report. Geneva, Switzerland: World Health Organization; 2007. This is a well-referenced detailed review of the rationale and methods for developing FRAX, the WHO computer-based fracture risk algorithm.

    Google Scholar 

  3. • World Health Organization: FRAX WHO Fracture Risk Assessment Tool. Available at http://www.shef.ac.uk/FRAX/. Accessed November 2009. The link to the online version of FRAX provides for input of BMD and VFA for estimation of the 10-year probability of fracture. This website is periodically updated to account for new data and the addition of new countries.

  4. •• Baim S, Binkley N, Bilezikian JP, et al.: Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 2008, 11:75–91. The ISCD Official Positions provide essential quality standards for the acquisition, analysis, interpretation, and reporting of BMD measurements and spine imaging with VFA.

    Article  PubMed  Google Scholar 

  5. Lewiecki EM, Laster AJ: Clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J Clin Endocrinol Metab 2006, 91:4215–4222.

    Article  CAS  PubMed  Google Scholar 

  6. Albanese CV, Diessel E, Genant HK: Clinical applications of body composition measurements using DXA. J Clin Densitom 2003, 6:75–85.

    Article  PubMed  Google Scholar 

  7. Yang L, Peel N, Clowes JA, et al.: Use of DXA-based structural engineering models of the proximal femur to discriminate hip fracture. J Bone Miner Res 2009, 24:33–42.

    Article  PubMed  Google Scholar 

  8. Lotz JC, Cheal EJ, Hayes WC: Fracture prediction for the proximal femur using finite element models: Part I–Linear analysis. J Biomech Eng 1991, 113:353–360.

    Article  CAS  PubMed  Google Scholar 

  9. Marshall D, Johnell O, Wedel H: Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996, 312:1254–1259.

    CAS  PubMed  Google Scholar 

  10. WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis: Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. Geneva Technical Report Series 843. Geneva, Switzerland: World Health Organization; 1994.

  11. Cranney A, Tugwell P, Wells G, Guyatt G: Systematic reviews of randomized trials in osteoporosis: introduction and methodology. Endocr Rev 2002, 23:497–507.

    CAS  Google Scholar 

  12. Wasnich RD, Miller PD: Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab 2000, 85:231–236.

    Article  CAS  PubMed  Google Scholar 

  13. Mazess R, Chesnut CH III, McClung M, Genant H: Enhanced precision with dual-energy X-ray absorptiometry. Calcif Tissue Int 1992, 51:14–17.

    Article  CAS  PubMed  Google Scholar 

  14. Njeh CF, Fuerst T, Hans D, et al.: Radiation exposure in bone mineral density assessment. Appl Radiat Isot 1999, 50:215–236.

    Article  CAS  PubMed  Google Scholar 

  15. Crawford RP, Cann CE, Keaveny TM: Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone 2003, 33:744–750.

    Article  PubMed  Google Scholar 

  16. Guglielmi G, Lang TF: Quantitative computed tomography. Semin Musculoskelet Radiol 2002, 6:219–227.

    Article  PubMed  Google Scholar 

  17. Lewiecki EM, Richmond B, Miller PD: Uses and misuses of quantitative ultrasonography in managing osteoporosis. Cleve Clin J Med 2006, 73:742–752.

    Article  PubMed  Google Scholar 

  18. Cranney A, Jamal SA, Tsang JF, et al.: Low bone mineral density and fracture burden in postmenopausal women. CMAJ 2007, 177:575–580.

    PubMed  Google Scholar 

  19. Cummings SR, Karpf DB, Harris F, et al.: Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 2002, 112:281–289.

    Article  CAS  PubMed  Google Scholar 

  20. Hochberg MC, Greenspan S, Wasnich RD, et al.: Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 2002, 87:1586–1592.

    Article  CAS  PubMed  Google Scholar 

  21. Lewiecki EM, Watts NB: Assessing response to osteoporosis therapy. Osteoporos Int 2008, 19:1363–1368.

    Article  CAS  PubMed  Google Scholar 

  22. Black DM, Cummings SR, Karpf DB, et al.: Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996, 348:1535–1541.

    Article  CAS  PubMed  Google Scholar 

  23. Cummings SR, Black DM, Thompson DE, et al.: Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998, 280:2077–2082.

    Article  CAS  PubMed  Google Scholar 

  24. Ettinger B, Black DM, Mitlak BH, et al.: Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999, 282:637–645.

    Article  CAS  PubMed  Google Scholar 

  25. Cummings SR, Palermo L, Browner W, et al.: Monitoring osteoporosis therapy with bone densitometry: misleading changes and regression to the mean. Fracture Intervention Trial Research Group. JAMA 2000, 283:1318–1321.

    Article  CAS  PubMed  Google Scholar 

  26. Lenchik L, Watts NB: Regression to the mean: what does it mean? Using bone density results to monitor treatment of osteoporosis. J Clin Densitom 2001, 4:1–4.

    Article  CAS  PubMed  Google Scholar 

  27. Bonnick SL: Monitoring osteoporosis therapy with bone densitometry: a vital tool or regression toward mediocrity? J Clin Endocrinol Metab 2000, 85:3493–3495.

    Article  CAS  PubMed  Google Scholar 

  28. Bell KJ, Hayen A, Macaskill P, et al.: Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: secondary analysis of trial data. BMJ 2009, 338:b2266.

    Article  PubMed  Google Scholar 

  29. Watts NB, Lewiecki EM, Bonnick SL, et al.: Clinical value of monitoring BMD in patients treated with bisphosphonates for osteoporosis. J Bone Miner Res 2009, 24:1643–1646.

    Article  CAS  PubMed  Google Scholar 

  30. Lewiecki EM, Rudolph LA: How common is loss of bone mineral density in elderly clinical practice patients receiving oral bisphosphonate therapy for osteoporosis? J Bone Miner Res 2002, 17(Suppl 2):S367.

    Google Scholar 

  31. Lewiecki EM: Nonresponders to osteoporosis therapy. J Clin Densitom 2003, 6:307–314.

    Article  PubMed  Google Scholar 

  32. Bouxsein ML, Delmas PD: Considerations for development of surrogate endpoints for antifracture efficacy of new treatments in osteoporosis: a perspective. J Bone Miner Res 2008, 23:1155–1167.

    Article  PubMed  Google Scholar 

  33. Watts NB, Miller PD, Kohlmeier LA, et al.: Vertebral fracture risk is reduced in women who lose femoral neck bone mineral density with teriparatide treatment. J Bone Miner Res 2009, 24:1125–1131.

    Article  CAS  PubMed  Google Scholar 

  34. Blake GM, Lewiecki EM, Kendler DL, Fogelman I: A review of strontium ranelate and its effect on DXA scans. J Clin Densitom 2007, 10:113–119.

    Article  PubMed  Google Scholar 

  35. Cooper C, O’Neill T, Silman A: The epidemiology of vertebral fractures. European Vertebral Osteoporosis Study Group. Bone 1993, 14(Suppl 1):S89–S97.

    Article  PubMed  Google Scholar 

  36. Genant HK, Wu CY, Van Kuijk C, Nevitt MC: Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993, 8:1137–1148.

    Article  CAS  PubMed  Google Scholar 

  37. Schousboe JT, DeBold CR: Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int 2006 17:281–289.

    Article  PubMed  Google Scholar 

  38. Black DM, Arden NK, Palermo L, et al.: Prevalent vertebral deformities predict hip fractures and new vertebral fractures but not wrist fractures. J Bone Miner Res 1999, 14:821–828.

    Article  CAS  PubMed  Google Scholar 

  39. Ferrar L, Jiang G, Eastell R, Peel NF: Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res 2003, 18:933–938.

    Article  CAS  PubMed  Google Scholar 

  40. Van der Klift M, De Laet CE, McCloskey EV, et al.: The incidence of vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res 2002, 17:1051–1056.

    Article  PubMed  Google Scholar 

  41. National Osteoporosis Foundation: Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2008.

    Google Scholar 

  42. Schousboe JT, Ensrud KE, Nyman JA, et al.: Potential cost-effective use of spine radiographs to detect vertebral deformity and select osteopenic post-menopausal women for amino-bisphosphonate therapy. Osteoporos Int 2005, 16:1883–1893.

    Article  PubMed  Google Scholar 

  43. Newman ED, Oleginski TP, Perruquet JL, Hummer JL: Vertebral fracture analysis using DXA- a clinically important and inexpensive method to improve osteoporosis risk assessment [abstract]. Arthritis Rheum 2005, 52(Suppl):S677.

    Google Scholar 

  44. Kanis JA, Barton IP, Johnell O: Risedronate decreases fracture risk in patients selected solely on the basis of prior vertebral fracture. Osteoporos Int 2005, 16:475–482.

    Article  CAS  PubMed  Google Scholar 

  45. Quandt SA, Thompson DE, Schneider DL, et al.: Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of −1.6 to −2.5 at the femoral neck: the Fracture Intervention Trial. Mayo Clin Proc 2005, 80:343–349.

    Article  CAS  PubMed  Google Scholar 

  46. Chesnut III CH, Skag A, Christiansen C, et al.: Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004, 19:1241–1249.

    Article  CAS  Google Scholar 

  47. Neer RM, Arnaud CD, Zanchetta JR, et al.: Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001, 344:1434–1441.

    Article  CAS  PubMed  Google Scholar 

  48. Lewiecki EM, Binkley N, Petak SM: DXA quality matters. J Clin Densitom 2006, 9:388–392.

    Article  PubMed  Google Scholar 

  49. Kanis JA, Johnell O: Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 2005, 16:229–238.

    Article  CAS  PubMed  Google Scholar 

  50. Lewiecki EM, Baim S, Siris ES: Osteoporosis care at risk in the United States. Osteoporos Int 2008, 19:1505–1509.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

  1. New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM, 87106, USA

    E. Michael Lewiecki

Authors
  1. E. Michael Lewiecki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Michael Lewiecki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lewiecki, E.M. Bone Densitometry and Vertebral Fracture Assessment. Curr Osteoporos Rep 8, 123–130 (2010). https://doi.org/10.1007/s11914-010-0018-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11914-010-0018-z

Keywords

Search

Navigation