Vallarta-Ast N, Krueger D, Wrase C, Agrawal S, Binkley N
University of Wisconsin Osteoporosis Research Program, 2870 University Avenue, Suite 100, Madison, WI 53705, USA.
Osteoporos Int. 2007 Oct;18(10):1405-10. doi: 10.1007/s00198-007-0381-5. Epub 2007 Apr 28.
The utility of, and potential indications for, densitometric vertebral fracture assessment were evaluated in 1,168 men. A bimodal fracture distribution was observed, identifying fractures in 17% of men with no fracture history. Osteopenia or height loss of > or = 2.5'' may be indications for VFA in men.
Densitometric vertebral fracture assessment (VFA) is an excellent means to detect unappreciated vertebral fractures in women. However, little evaluation of VFA in men has been performed. This study evaluated VFA utility and explored potential VFA indications in men.
The study cohort consists of a population of 1,168 men (mean age, weight and BMI of 69.1 years, 188.8 pounds and 28.1 kg/m(2), respectively) referred for clinically indicated bone mineral density (BMD) measurement at the Wm. S. Middleton VAMC. Lateral VFA images and scans of the lumbar spine, proximal femur and non-dominant radius, were obtained by two technologists using a GE Healthcare Lunar Prodigy densitometer. Vertebral fractures were defined using the Genant visual semi-quantitative approach.
Seventy-eight percent of vertebrae from T4-L5 and 93% from T8-L5 were adequately visualized on VFA. Vertebral fractures were detected in 32% (374/1,168) of these men. A bimodal distribution was observed with fractures being most common in the mid-thoracic spine and at the thoraco-lumbar junction. As would be expected, the prevalence of VFA-detected fractures increased with age and as BMD declined. Fracture prevalence did not increase until a historical height loss of > or = 6.4 cm (2.5 inches) was reported. VFA-identified fractures were present in 17% of men who had no history of fracture. Furthermore, in men with densitometric osteopenia, no historical fracture and absence of glucocorticoid use (n = 158), vertebral fractures were detected in 18%.
VFA allows evaluation of the majority of vertebral bodies in men and identifies a substantial number of individuals with previously unappreciated fracture. Additionally, a more stringent height loss requirement, perhaps 2.5 inches or more, or densitometric osteopenia (low bone mineral density by DXA), may be appropriate as indications for performance of VFA in men.
对1168名男性进行了骨密度椎体骨折评估的效用及潜在适应症的评估。观察到骨折分布呈双峰模式，在无骨折病史的男性中，有17%发现了骨折。骨质减少或身高降低≥2.5英寸可能是男性进行椎体骨折评估（VFA）的适应症。
骨密度椎体骨折评估（VFA）是检测女性未被察觉的椎体骨折的极佳方法。然而，对男性VFA的评估很少。本研究评估了VFA的效用，并探索了男性VFA的潜在适应症。
研究队列包括1168名男性（平均年龄、体重和体重指数分别为69.1岁、188.8磅和28.1kg/m²），他们因临床需要在威廉·S·米德尔顿退伍军人医疗中心进行骨密度（BMD）测量。由两名技术人员使用通用电气医疗集团的Lunar Prodigy骨密度仪获取腰椎、近端股骨和非优势桡骨的侧位VFA图像及扫描结果。采用Genant视觉半定量方法定义椎体骨折。
T4-L5椎体中78%以及T8-L5椎体中93%在VFA上能得到充分显影。这些男性中32%（374/1168）检测到椎体骨折。观察到骨折分布呈双峰模式，骨折在胸中段脊柱和胸腰交界处最为常见。正如预期的那样，VFA检测到的骨折患病率随年龄增长和骨密度下降而增加。直到报告有≥6.4厘米（2.5英寸）的既往身高降低时，骨折患病率才会增加。在无骨折病史的男性中，17%存在VFA识别出的骨折。此外，在骨质减少、无既往骨折且未使用糖皮质激素的男性（n = 158）中，18%检测到椎体骨折。
VFA能够评估男性的大多数椎体，并识别出大量既往未被察觉骨折的个体。此外，对于男性进行VFA检查，更严格的身高降低要求（可能为2.5英寸或更多）或骨质减少（通过双能X线吸收法测量的低骨密度）可能作为适应症是合适的。
