Bone Abstracts (2015) 4 P123 | DOI: 10.1530/boneabs.4.P123

Does the introduction of vertebral fracture assessment change clinical practice?

Dee Chapman, Jacky Walford, Nicholas Shaw, Wolfgang Högler & Nicola Crabtree


Birmingham Children’s Hosptial, Birmingham, UK.


Introduction: Since the definition of osteoporosis in children changed following the revised ISCD guidelines of 2013, the presence of vertebral fractures has become more clinically important, in particular since vertebral fractures may occur despite apparently normal bone density (www.iscd.org). Although the detection of vertebral fractures in children is still largely dependent on lateral spine x-rays, the introduction of new higher resolution bone densitometry scanners has lead to the possibility of vertebral fracture assessment (VFA). We have reviewed our use of x-rays and VFA over the past 10 years to determine how VFA availability is leading to a change in clinical practice.

Methods: We reviewed x-rays and VFA scans in 163 children with osteogenesis imperfecta (OI) from 2004–2014 performed in a single centre. We calculated the proportion of children who had either a spine x-ray and/or VFA at the time of, or close to their annual DXA scan utilising either a GE Lunar Prodigy (2004–2010) or a GE Lunar iDXA (from 2010) bone densitometer.

Results: The attached figure shows a change in the proportion of spine x-rays (per DXA referral) of 65 to 93% from 2004 to 2010 and then a subsequent drop to 3% in 2014. The proportion of VFA scans increased from 5 to 89% between 2010 and 2014 with the most dramatic increase seen between 2012 and 2013.

Conclusion: The increase in proportion of spine x-rays from 2008 to 2010 reflects the increasing clinical importance of x-rays as a screening for asymptomatic vertebral fractures. However, the change in the proportion of VFA scans compared to x-rays in recent years reflects the availability and reliability of new generation DXA scanners. The added value of VFA scans is the significant reduction in radiation dose and increased convenience to the patients.

Disclosure: The authors declared no competing interests.

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