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Vertebral fracture assessment in patients presenting with incident nonvertebral fractures


Alastair R. McLellan, Division of Cardiovascular Sciences and Medicine, Gardiner Institute, Western Infirmary, 44 Church Street, Glasgow G11 6NT, UK. Tel.: +44(0) 141 2112513; E-mail:


Background  Patients with fractures should be prioritized for assessment for osteoporosis so that they can benefit from treatment for the secondary prevention of osteoporotic fractures. Assessment is seldom offered to patients with vertebral fractures because these fractures are typically not diagnosed. Vertebral fractures can be identified by vertebral fracture assessment (VFA) using current dual-energy X-ray absorptiometry (DXA) scanners.

Objective  The purpose of this study was to assess the prevalence of vertebral fractures, using VFA, in patients presenting with nonvertebral fractures and to assess whether this impacts on the management of these patients.

Design  A cohort study undertaken in 577 patients aged 50 years or over including 455 women, who presented with nonvertebral fractures and who underwent routine post-fracture assessment by a Fracture Liaison Service (FLS).

Measurements  The numbers and severity of vertebral fractures were assessed in evaluable vertebrae from TV4 to LV4 in addition to bone mineral density (BMD) assessment.

Results  Using DXA, 76% of vertebrae could be evaluated by VFA. Of the men and women with nonvertebral fractures, 19–20% had at least one vertebral fracture. The prevalence ranged from 6% in men with humeral fractures to 32% among women with hip fractures. The prevalence of vertebral fractures correlated most strongly with increasing age and with severity of reduction of BMD. Using local treatment protocols, VFA would result in only 3% more patients receiving treatment for fracture secondary prevention.

Conclusions  In patients with nonvertebral fractures, VFA identifies a substantial burden of prevalent vertebral fractures that have not hitherto been recognized. Nevertheless, VFA seldom influences the need for treatment for fracture secondary prevention after a nonvertebral fracture.