The vertebrae (bones in the spine) can gradually crumble or suddenly crunch. The resulting minor ache is often mistaken for arthritis or a pulled muscle. Gradual crumbles are “morphometric” (detected by x-ray) fractures, and just as valid as “clinical” (recognized) fractures in predicting Fracture Risk and future fractures.
Vertebral Fracture Assessment (VFA) looks at the spine from the side with a DXA machine or a standard x-ray. Each vertebra is evaluated for wedging (crunching or crumbling in the front) or biconcave deformity (from the discs punching in the center of the vertebra from top and bottom). A single vertebral deformity by 25% or more diagnoses “Clinical Osteoporosis” pre-empting DXA, BMD, and FRAX. VFA is an additional standard for assessing Fracture Risk.
VFA requires a human to look at each vertebra from T4 through L4 for deformity. VFA by DXA machine requires 2 more pictures than the 3 standard DXA pictures. VFA is a different technology from DXA and is not part of a basic DXA report. VFA is additional information that supplements DXA.
Humpback deformity in a patient is a strong hint that VFA will probably find multiple vertebral wedge compression fracture deformities. Wedge deformities can often be suspected by finding humpback (kyphosis). But multiple biconcave compression fracture deformities can hide in a patient with a straight spine. VFA is usually required to find biconcave deformities. VFA needs to be part of a Complete Bone Health Evaluation to fully assess fracture risk.
Last time we discussed DXA. Today we discussed VFA. Thursday we discuss what I discovered by combining the two in a Complete Bone Health Evaluation on every patient.
Jay Ginther, MD
DXA has been the standard screening test for Osteoporosis in the USA for two decades. DXA is easy to obtain and the computer print-out makes it look very simple to read. Too simple if all you do is look at the computer print-out. DXA is not the whole story. And that is not the only difficulty.
DXA measures Bone Mineral Density (BMD). Calcium is the usual mineral in bone, and the one we intend to measure. The computer reads out calcium g/cm2 (a bit hard to understand) and also gives a “t-score” comparing the test result to a healthy 30 year old woman. That makes it simple – “normal”, “osteopenia”, or “osteoporosis”. Again, much too simple if what you really want to know is Fracture Risk.
A Blue Zone Whirlwind hit our house. Grammy Ann & Papa Jay barely survived. Grandson RJ stayed with us for a week. He is a 2 1/2 year old whirlwind, constantly busy, constantly wanting an adult to participate in his adventures. Constantly asking – why? why? why?
He “watched” Mary Poppins so he could dance like Bert (Dick van Dyke) in the chimney-sweeps on the rooftops scene, “play that again”. His volume control has only “louder” for a setting.
“Men are from Mars”, so March is a good time to think about men, the overlooked minority in osteoporosis. The American Journal of Men’s Health has published a study of osteoporosis screening rates for men over age 70. The results are discouraging.
Osteoporosis screening at age 70 for men with no identified risk factors, and earlier for those with known risk factors, has been recommended by the National Osteoporosis Foundation (NOF) and Medicare since 2008. 25 % of persons known to have osteoporosis are men. Yet we still perceive osteoporosis to be women only . We ignore the male minority.