Diagnosis of Asymptomatic Osteoporotic Fractures Using Vertebral Fracture Assessment

Using vertebral fracture assessment (VFA) may aid in diagnosis of asymptomatic VFs in approximately one-third of postmenopausal women and can lead to more appropriate medical treatment, according to study results published in Bone.

Although VFs are frequently asymptomatic, they are associated with increased morbidity and mortality, including increased risk for subsequent fractures. VFs are usually diagnosed based on spine x-rays, but lateral dual-energy x-ray absorptiometry scanning of the entire spine for VFA may also be useful. The goal of the current study was to complete a systematic review and meta-analysis to describe the prevalence of VFA-detected VFs in asymptomatic postmenopausal women.

Two reviewers conducted a systematic search of databases including MEDLINE, Web of Science, and the Cochrane Central Register of Controlled Trials between January 2000 and January 2018. They included both randomized clinical trials and observational studies that reported VF prevalence data.

Of 1777 articles identified, 28 studies met the inclusion criteria and were analyzed, totaling 25,418 postmenopausal women with mean ages between studies ranging from 59.5 to 86.2 years. Most of the selected studies were cross-sectional and only 2 had longitudinal follow-up. The sample sizes varied widely across the studies, from 63 to 5156 participants.

Overall, the weighted pooled prevalence of VF in asymptomatic women was 28% (95% CI, 23-32). Among women who had VFs, the prevalence of osteoporosis was up to 64.6%. The prevalence of VF was almost identical in community-based (28%; 95% CI, 22-34) and hospital-based (27%; 95% CI, 22-32) study populations.

In 6 studies in which women had a mean age of <65 years, the weighted pooled prevalence of VF was 41% (95% CI, 27-55), whereas in studies of women who had a mean age of ≥65 years, the pooled prevalence was 24% (95% CI, 20-27).

The researchers acknowledged several study limitations, including significant heterogeneity across studies, limitations of VFA to assess all vertebral levels, lack of individual-level data on demographics, and potential publication bias in the selected studies.

“Our results have demonstrated that using VFA in asymptomatic women is likely to identify prevalent VF in approximately one third of women, many of whom do not have osteoporosis. The identification of subclinical VFs may lead to initiation of pharmacological treatment in individuals, who may not otherwise be treated which could lead to substantial reductions in future fracture risk,” wrote the researchers.

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Reference

Yang J, Mao Y, Nieves JW. Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: a systematic review and meta-analysis [published online April 3, 2020]. Bone. doi:10.1016/j.bone.2020.115358