Posts Tagged ‘Vertebral Fracture Assessment’
Treat to Target of NO NEW FRACTURES. How do we find that target? DXA >-2.5 is a start. Fragility fractures increase new fracture risk. FRAX adds many more risk factors to the calculation and TBS refines FRAX.
Vertebral Fracture Assessment (VFA) looks at the spine from the side and independently identifies additional fracture risk. This can be done on a DXA machine or by x-ray. A single vertebral compression fracture of 25% or more pre-empts DXA, BMD, and FRAX in diagnosing Clinical Osteoporosis and recommending treatment.
VFA should be done because the majority of vertebral compression fractures are first noticed by x-ray or DXA VFA imaging. If you do not personally view the images, be sure the radiologist specifically checked for vertebral deformities as described by Genant.
I recently published my retrospective review of 1259 sequential first time VFA patients in Endocrine Practice 2017:23:1375-8.
VFA identified many patients not identified as high fracture risk (Clinical Osteoporosis) by DXA or fragility fracture or height loss or kyphosis or FRAX.
We should consider including VFA in every first time Complete Bone Health Evaluation.
And how should we treat? Next time…
Jay Ginther, MD
Driving to Chicago in February was cold and snowing. But it was hot indoors at the ISCD (International Society for Clinical Densitometry) Annual Meeting and Position Development Conference (PDC).
While no new technologies were introduced, the PDC evaluated the scientific studies of several recent innovations. Most are best done in research centers. One recent innovation could make it to clinical centers. Trabecular Bone Score (TBS) is a software addition to DXA that adds information about the quality of bone by re-analyzing the L1, L2, L3 vertebrae.
We have discussed how adding Vertebral Fracture Assessment (VFA) to a DXA Bone Mineral Density (BMD) improves Fracture Risk calculation. TBS has the same potential. The main issues blocking TBS are software cost, added time, and the fact that all insurances (including Medicare) currently do not pay for it.
We also attended presentations about patient treatment issues. Fracture Prevention is much more than just checking a T-score with DXA. National experts shared their knowledge of medical issues that can strongly influence Bone Health and Fracture Risk. More about these sessions next time.
You can Take Control of your Future with action to decrease your fracture risk.
Jay Ginther, MD
DXA is very good at determining Bone Mineral Density (BMD), provided you look at the images and over-read the computer. DXA alone is less good at predicting Fracture Risk. But, Fractures are what we want to avoid.
At the International Society for Clinical Densitometry (ISCD) meeting this week, we will discuss the other modalities, which supplement DXA to obtain greater accuracy. Vertebral Fracture Assessment (VFA) helps evaluate bone quality. FRAX was specifically designed to predict Fracture Risk. QCT (Quantitative Computerized Tomography) has been added in recent years as an alternative to DXA.
ISCD will discuss adding TBS (Trabecular Bone Score), Hip Structural Analysis, Hip Axis Length, and uses of Central CT. We are constantly pushing toward our goal – Prevent Fractures.
Preventing Fractures is not just DXA. Get a Complete Bone Health Evaluation.
Take Control of your future. Check your bone health.
Jay Ginther, MD
Sometimes a person breaks a hip first, then they fall. This happens a lot more often than we realize. When the break is just below the ball of the hip, the fracture may have come before the fall. Moreover, that Fragility Fracture may have gradually developed over days or weeks.
How is it possible that a person does not realize that the hip is gradually crumbling? We call it a Stress Fracture when a crack gradually developes. Small cracks gradually getting bigger are usually not recognized until they are completely across the bone and it breaks, causing the patient to fall. Why?
The aching pain of a stress fracture is often too gradual to distinguish from arthritis pain until the break is complete and the whole bone collapses. The best way to see this process is to watch a video of the I-35W bridge collapsing in Minneapolis on 1st August 2007. http://search.yahoo.com/search?ei=utf-8&fr=aaplw&p=i35w+collapse Tiny cracks slowly developed in the steel until one day……..THUD!
How can you detect who is at high Hip Fracture Risk? A very low DXA T-score, especially in the spine, is a good indication. But DXA often fails if the spine is already crumbling or has arthritis. A better indication is Vertebral Fracture Assessment (VFA). Looking at the spine from the side, Vertebral Compression Deformities can indicate crumbling spongy bone in the spine before the spongy bone in the hip also crumbles.
Know where you stand. Get a Complete Bone Health Evaluation. Take Control of your future.
Jay Ginther, MD