Rheumatology Department, Paris-Descartes University, Paris, France.
Rheumatology (Oxford). 2011 Dec;50(12):2264-9. doi: 10.1093/rheumatology/ker225. Epub 2011 Oct 19.
Vertebral fracture assessment (VFA) is a radiographic method using DXA to diagnose vertebral fractures, validated for reproducibility, sensitivity and specificity as compared with spine radiographs. This study was designed to assess the impact of VFA results on decision-marking in osteoporosis, using a clinical vignette-based approach.
Twenty-nine rheumatologists provided data on post-menopausal women consulting for BMD measurement: clinical risk factors for osteoporosis, clinical characteristics of patients, BMD, T-score and VFA images. Standardized clinical vignettes were generated from these patients, and each rheumatologist assessed five vignettes assigned at random, in two distinct steps: first step without and second step with VFA data. At each step, they had to answer questions about the prescription of radiographs and treatments, using a yes/no format.
A total of 117 vignettes were available [117 patients: mean age 65.1 (10.1) years, lumbar spine T-score: -1.64 (0.92)], 36.7% with a personal history of fracture. Rheumatologists intended to prescribe radiographs in 62.4 and 46.2% cases (P = 0.0206) before and after VFA results, respectively; a change occurred in 36.8% of patients, i.e. a de novo prescription of radiographs in 12 patients, and a deleted prescription in 31 patients. VFA data induced a therapeutic change for 30.8% of patients.
This study shows that VFA results influence patient management, both for radiographs and treatment prescriptions.
椎体骨折评估（VFA）是一种使用 DXA 对椎体骨折进行诊断的放射学方法，与脊柱 X 光片相比，该方法具有可重复性、敏感性和特异性。本研究旨在通过基于临床病例的方法评估 VFA 结果对骨质疏松症决策制定的影响。
29 名风湿病学家提供了绝经后妇女因 BMD 测量就诊的临床危险因素、患者的临床特征、BMD、T 评分和 VFA 图像数据。从这些患者中生成了标准化的临床病例，并由每位风湿病学家随机评估五个病例，分两个独立步骤进行：第一步无 VFA 数据，第二步有 VFA 数据。在每个步骤中，他们必须使用是/否格式回答关于 X 光片和治疗处方的问题。
共提供了 117 个病例[117 名患者：平均年龄 65.1（10.1）岁，腰椎 T 评分：-1.64（0.92）]，36.7%有个人骨折史。在 VFA 结果之前和之后，风湿病学家分别打算在 62.4%和 46.2%的情况下开具 X 光片（P = 0.0206）；36.8%的患者发生了变化，即 12 名患者新处方 X 光片，31 名患者删除了 X 光片处方。VFA 数据导致 30.8%的患者治疗方案发生改变。
本研究表明，VFA 结果会影响患者的管理，无论是 X 光片还是治疗方案。
