Bone Abstracts (2014) 3 PP242 | DOI: 10.1530/boneabs.3.PP242

A systematic review of diagnostic accuracy of VFA using DXA in people aged over 50

Deog-Yoon Kim1, Yu Kyung Lee2, YoungEun Lee2, Sung-Hee Oh2, Jin-Seub Hwang2, Jinhee Kim2, Joo-Hyun Lee3, Junhee Pyo4, Dam Kim5, Yun Young Choi5, Sang-Cheol Bae5 & Yoon-Kyoung Sung5


1Kyung Hee Univeristy, Seoul, Republic of Korea; 2National Evidence-based healthcare Collaborating Agency, Seoul, Republic of Korea; 3Inje University, Goyang, Republic of Korea; 4Tufs Medical Center, Boston, Massachusetts, USA; 5Hanyang University, Seoul, Republic of Korea.


Objective: The postmenopausal women and elderly men have a big burden for osteoporosis related vertebral fracture and the frequency of clinically unrecognized vertebral fracture is known to be increasing. Vertebral Fracture Assessment (VFA) using DXA is a convenient and safe method to patients together with bone density test and is reported to be proper as a screening method to prevent additional vertebral fracture as diagnosing the vertebral fracture with unrecognized symptoms beforehand. This study aimed to perform a systematic review to examine the overall diagnostic performance of VFA using DXA in identifying the vertebral fracture.

Methods: We searched potentially relevant studies using electronic databases, such as Ovid-Medline, Ovid-EMBASE, Cochrane library, KoreaMed, Kmbase, KISS, RISS from their inceptions to May 2013. Two independent reviewers extracted data using a standardized form. The quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). To perform the data composition of the diagnostic accuracy, we constructed the forest plot, SROC curve and bivariate random models. The unexplained heterogeneity among each study existed. Therefore, it was decided to be not proper to combine sensitivity and specificity, and we performed the qualitative data analysis.

Results: Overall, the studies had ‘poor’ methodological quality. In the study with the best quality evaluation result, the sensitivity in the vertebra level was 0.70–0.73, the specificity was 0.96–0.99 and the sensitivity in the patient level was 0.82 and the specificity was 0.93. Generally, the sensitivity in the patient level showed the higher figure than that in the vertebra and the figure of specificity was higher than that of sensitivity.

Conclusion: The VFA using DXA appeared to have a moderate sensitivity and a high specificity for detecting vertebral fracture.