Vertebral Morphometry

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Algorithm-Based Qualitative Method

The diagnosis of vertebral fractures is usually based on the presence of a deformation of vertebral body on lateral spinal radiographs, but a vertebral deformity is not always a vertebral fracture.24 Because there is no consensus on the exact definition of a vertebral fracture, it may sometimes be difficult to discriminate the prevalent vertebral fracture from a normal variant of vertebral shape or from a vertebral deformation that may have occurred long ago, especially in mild cases. The

Vertebral morphometry

Vertebral morphometry is a quantitative method to identify osteoporotic vertebral fractures based on the measurement of vertebral heights. Vertebral morphometry may be performed on conventional spinal radiographs (MRX: morphometric x-ray radiography) or on images obtained from dual x-ray absorptiometry (DXA) scans (MXA: morphometric x-ray absorptiometry).

Morphometric definition of vertebral fractures

There is no gold standard for osteoporotic fracture. Definition of vertebral fracture is based on the differences in anterior, middle, or posterior vertebral heights within a vertebra, or between adjacent vertebrae.44, 45

However, there is variation in vertebral body (VB) size and shape at different levels of the spine for the construction of thoracolumbar curvatures, which reduce bending moments created by upright posture and so provide stability during motion.46 The VB is anteriorly wedged

Comparison of SQ and MRX for the identification of vertebral fractures in osteoporosis

Some comparative studies67, 68, 69 found a high concordance between different MRX approaches and the visual SQ method in the evaluation of prevalent vertebral fractures defined as moderate or severe (Fig. 6). In these cases there was a strong association with clinical parameters (bone mineral density, height loss, back pain, incidence of subsequent deformities). There were discrepancies between SQ and quantitative morphometry approaches in the detection of mild fractures as classified by an

Vertebral fracture assessment by dual-energy X-ray absorptiometry

Vertebral fracture assessment (VFA) is the correct term for designating the assessment of lateral spine views acquired by DXA to detect vertebral fractures, using new-generation densitometers of 2 major manufacturers: Hologic, Inc (Bedford, MA, USA) and GE Medical Systems (Lunar, Madison, WI, USA). DXA scan of the spine is performed either by using a rotating arm (Hologic QDR 4500A, QDR Delphi, GE-Lunar Expert) with the patient lying supine or by placing the patient on in the left decubitus

Comparison between conventional radiography and DXA images

The main attraction of DXA is that the effective dose-equivalent to the patient is considerably lower (42 μSv) than for conventional radiography (500 μSv).79, 80 When using the scanning fan-beam geometry of DXA devices, the X-ray beam is parallel to the endplates, instead of being fan-shaped as during conventional radiography, which eliminates problems related to image amplification and geometric distortion.81 Whereas the DXA technique is able to acquire the entire spine in a single image, in

Clinical applications of VFA

To identify vertebral fractures on DXA images the visual SQ method and vertebral morphometry (MXA) are used, as on radiographs.

Several studies have been performed to compare the DXA images to the gold standard lateral spine radiographs for the detection of vertebral fracture. First, in a large study it has been demonstrated that reference ranges of vertebral heights derived from standard radiographs could not be applied to VFA on DXA images, in view of the observed differences between their MXA

Can vertebral morphometry predict a vertebral fracture?

The aim of osteoporosis treatment is to decrease the risk of fracture, particularly in individuals at high risk. Although bone mass is an important determinant of the risk of fracture, other factors contribute to skeletal fragility. There are several clinical factors (age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis, and the use of oral glucocorticoids) that, in conjunction with BMD, can be integrated to provide estimates of 10-year

Summary

For epidemiologic studies and clinical drug trials in osteoporosis research, and to minimize subjective biases intrinsic to qualitative readings and homogenize data analysis, visual SQ assessment of the radiographs by a trained and experienced observer is the gold standard method to detect vertebral fractures.109, 110 In clinical practice, the preferred method is also radiographic SQ assessment, because an expert eye can better distinguish between true fractures and vertebral anomalies than can

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