Laster Andrew J, Lewiecki E Michael
Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, NC 28207, USA.
J Clin Densitom. 2007 Jul-Sep;10(3):227-38. doi: 10.1016/j.jocd.2007.04.002. Epub 2007 Jun 28.
Clinical trial data and fracture risk prediction models unequivocally demonstrate the utility of identifying prevalent vertebral fractures to predict future fractures of all types. Knowledge of prevalent vertebral fractures can alter patient management decisions and result in initiation of therapy to reduce fracture risk in some patients who would not otherwise be treated. Cost-benefit analysis demonstrates that identifying and treating patients with vertebral fractures, even those with a densitometric classification of osteopenia, is cost effective. Vertebral fractures can be readily identified in the office setting using standard radiography or Vertebral Fracture Assessment (VFA), a software addition to a central dual-energy X-ray absorptiometry (DXA) machine. In the United States, VFA was assigned a Current Procedural Terminology (CPT) code in January 2005. Nevertheless, coverage of VFA has not been uniformly embraced by Medicare carriers, companies that contract with the federal government to administer Medicare coverage and process claims for a region of the United States. Unlike DXA, for which uniform national coverage of qualified Medicare beneficiaries is mandated by the Balanced Budget Act of 1997, VFA coverage policies are determined by the local Medicare carriers. Third-party insurers are also variable in their coverage of VFA. This International Society for Clinical Densitometry (ISCD) White Paper documents the role of VFA in the evaluation and treatment of women with postmenopausal osteoporosis and compares it with standard spine radiography. Arguments used by some Medicare carriers and insurers to deny coverage of VFA in the United States are analyzed and critiqued. For health care providers within the United States, this White Paper may serve as a resource to respond to insurers who deny coverage of VFA. For health care providers regardless of their country, this article underscores the value of VFA as an alternative to spine radiography in the evaluation and management of postmenopausal women with suspected osteoporosis.
临床试验数据和骨折风险预测模型明确表明，识别现患椎体骨折对于预测所有类型的未来骨折具有实用性。了解现患椎体骨折情况可改变患者的管理决策，并促使对某些原本不会接受治疗的患者启动治疗以降低骨折风险。成本效益分析表明，识别并治疗椎体骨折患者，即使是骨密度分类为骨质减少的患者，也是具有成本效益的。使用标准X线摄影或椎体骨折评估（VFA，一种中央双能X线吸收仪（DXA）机器的软件附加功能）可在门诊环境中轻松识别椎体骨折。在美国，VFA于2005年1月被赋予了现行程序编码（CPT）。然而，医疗保险承保公司（与联邦政府签约管理医疗保险覆盖范围并处理美国某一地区索赔的公司）对VFA的覆盖范围并未统一接受。与DXA不同，1997年《平衡预算法案》规定了对符合条件的医疗保险受益人的全国统一覆盖，而VFA的覆盖政策由当地医疗保险承保公司决定。第三方保险公司对VFA的覆盖范围也各不相同。本国际临床骨密度测量学会（ISCD）白皮书记录了VFA在绝经后骨质疏松症女性评估和治疗中的作用，并将其与标准脊柱X线摄影进行了比较。分析并批评了美国一些医疗保险承保公司和保险公司拒绝承保VFA所使用的理由。对于美国境内的医疗服务提供者而言，本白皮书可作为回应拒绝承保VFA的保险公司的参考资料。对于无论来自哪个国家的医疗服务提供者来说，本文强调了VFA作为疑似骨质疏松症绝经后女性评估和管理中脊柱X线摄影替代方法的价值。
