Lewiecki E Michael, Laster Andrew J
New Mexico Clinical Research and Osteoporosis Center, Albuquerque, New Mexico 87106, USA.
J Clin Endocrinol Metab. 2006 Nov;91(11):4215-22. doi: 10.1210/jc.2006-1178. Epub 2006 Aug 29.
Vertebral fracture (VF) is the most common type of fragility fracture, yet most VFs are not clinically apparent. VFs are associated with a significant increase in morbidity, mortality, and risk of future fracture. Many patients with VFs do not have T-scores classified as osteoporosis. Knowledge of VFs may change diagnostic classification, estimation of future fracture risk, and clinical management. VF assessment (VFA) by dual-energy x-ray absorptiometry is a method for imaging the spine to diagnose VFs.
Background information and medical evidence on the technology and clinical applications of VFA was acquired by electronic searching of PubMed for appropriate terms that included vertebral fracture, imaging, diagnosis, dual-energy x-ray absorptiometry, and cost effectiveness. Matches with the highest levels of medical evidence were selected for review, recognizing that the new and evolving nature of the field required inclusion of some material that relied partly on expert opinion.
The sensitivity and specificity of VFA compare favorably with spine radiographs in the ability to diagnose grade 2 and 3 VFs. VFA involves less radiation, lower cost, and often greater patient convenience than spine radiography. Cost effectiveness modeling suggests that imaging of the spine in selected patients provides essential diagnostic and therapeutic information at a nominal cost. Patients with T-scores that are classified as low bone mass (osteopenia) who are selected for pharmacological therapy based on the presence of a VF benefit by reduction in fracture risk. Guidelines for the clinical application of VFA have been developed by the International Society for Clinical Densitometry.
VFA is a technology for diagnosing VFs that may alter diagnostic classification, improve fracture risk stratification, and identify patients likely to benefit from pharmacological therapy who otherwise might not be treated.
椎体骨折（VF）是最常见的脆性骨折类型，但大多数椎体骨折在临床上并不明显。椎体骨折与发病率、死亡率以及未来骨折风险的显著增加相关。许多椎体骨折患者的T值并未被归类为骨质疏松症。对椎体骨折的了解可能会改变诊断分类、未来骨折风险的评估以及临床管理。通过双能X线吸收法进行椎体骨折评估（VFA）是一种对脊柱进行成像以诊断椎体骨折的方法。
通过在PubMed上电子搜索包括椎体骨折、成像、诊断、双能X线吸收法和成本效益等适当术语，获取了关于VFA技术和临床应用的背景信息及医学证据。选择了具有最高医学证据水平的匹配项进行综述，认识到该领域的新特性和不断发展需要纳入一些部分依赖专家意见的材料。
在诊断2级和3级椎体骨折的能力方面，VFA的敏感性和特异性优于脊柱X光片。与脊柱X光摄影相比，VFA辐射更少、成本更低，且通常对患者更方便。成本效益模型表明，对选定患者的脊柱成像以名义成本提供了重要的诊断和治疗信息。因椎体骨折而被选择进行药物治疗的骨量低（骨质减少）T值患者，骨折风险降低。国际临床骨密度测量学会已经制定了VFA临床应用指南。
VFA是一种诊断椎体骨折的技术，可能会改变诊断分类、改善骨折风险分层，并识别可能从药物治疗中获益但否则可能不接受治疗的患者。
