Background Patients presenting at a fracture liaison service (FLS) with a prevalent non-vertebral fracture have a high prevalence of vertebral fractures. However, the diagnosis of a vertebral fracture can only be based on imaging of the spine. VFA is a low-radiation method for diagnosing a vertebral fracture at the same time as a DXA is performed.
Objectives To analyse the effect of systematic implementation of VFA in FLS patients on the diagnosis of prevalent vertebral fractures.
Methods Systematic use of VFA to diagnose prevalent vertebral fractures in 352 consecutive patients presenting at the outpatient FLS of the Maastricht University Medical Centre for fracture risk evaluation because of a recent non-vertebral fracture, compared to 1000 patients who received standard care before the introduction of the FLS (pre-FLS). The presence of vertebral fractures with VFA and X-ray was evaluated semi-quantitatively according to the Genant score.
Results In pre-FLS patients, 5% had a DXA, and no patient had a VFA. VFA was performed in 352 consecutive patients (mean age 65 yrs, 71% women) who were able and willing to participate in the FLS and had additional X-ray of the spine when indicated. Sixty patients (17%) had one or more vertebral deformities ≥ grade 1 on VFA (p<0.001 versus pre-FLS) and VFA was not possible to interpret because of bad image quality in 7 patients.
Of these 60 patients, 30 (50%) had one or more moderate (grade 2) or severe (grade 3) vertebral deformities on VFA (9% of all patients). In 37 patients (11% of all patients) an additional X-ray was performed because of doubt about the degree of deformity (n=30) or an insufficient image quality (n=7) on VFA. Of these patients, 32 had a vertebral fracture ≥grade 2. As a result, 62 patients were diagnosed with a prevalent vertebral fracture (18% of all patients) and 22 of them (7% of all patients) had 2 or more vertebral fractures. Vertebral fractures were diagnosed in 23% of patients with osteoporosis (any T-score in spine or hip <-2.5), in 17% of patients with osteopenia and in 2% of patients with normal BMD.
Conclusions Systematic implementation of VFA in FLS assessment resulted in the diagnosis of one or more previously unknown vertebral fractures in one out of five patients who attended the FLS with a recent non-vertebral fracture. In 11% of all patients an additional X-ray was performed to confirm or exclude a vertebral fracture.
Disclosure of Interest None Declared