Reniu Aina Capdevila, Ong Terence, Ajmal Syed, Sahota Opinder
Department of Internal Medicine, Hospital Clínic of Barcelona, University of Barcelona, 170 Villarroel, 08036, Barcelona, Spain.
Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
Arch Osteoporos. 2017 Dec;12(1):23. doi: 10.1007/s11657-017-0318-3. Epub 2017 Feb 28.
Twenty-five percent of patients with a non-hip non-vertebral fragility fracture have an undiagnosed vertebral fracture detected by vertebral fracture assessment during bone densitometric assessment. The prevalence of an undiagnosed vertebral fracture is higher in older people, and they are more likely to have multiple vertebral fractures.
Most vertebral fragility fractures (VFF) have no history of trauma. Vertebral fracture assessment (VFA) during dual energy x-ray absorptiometry (DXA) can be used to detect these VFFs. This study aims to identify the prevalence of undiagnosed VFF in patients presenting with a non-hip non-vertebral fragility fracture.
Patients identified by the fracture liaison service (FLS) of a large UK university hospital presenting with a non-hip non-vertebral fragility fracture were evaluated from 1 January 2012 to 30 September 2015. Local protocol identified those that would proceed for VFA. Data was collected on patient characteristics, fracture details, bone mineral density (BMD) measurements and VFA results.
Five hundred sixty-seven patients (mean (SD) age, 72 (9.4) years) of mostly women (88.3%) had a VFA performed as part of their DXA assessment. One hundred forty-three patients (25.2%) were identified to have a vertebral fracture, of whom 57.3% of them had one fracture. 49.5% of those with vertebral fractures had BMD measurements diagnostic of osteoporosis. Mean (SD) age was higher in those with vertebral fractures compared to those without; 74.9 (8.3) years vs 70.4 (9.5) years, p < 0.00. Those aged 75 years and over were more likely to have multiple fractures than those younger than 75 years (16.3 vs 4%, p = 0.01).
A quarter of patients presenting with a non-hip non-vertebral fragility fracture have an undiagnosed vertebral fracture. Older people are more likely to have vertebral fractures and more likely to have multiple fractures. VFA during bone densitometric assessment can further aid stratifying future fracture risk.
25%的非髋部非椎体脆性骨折患者在骨密度测量评估期间通过椎体骨折评估检测出有未诊断出的椎体骨折。未诊断出的椎体骨折在老年人中的患病率更高，并且他们更有可能有多处椎体骨折。
大多数椎体脆性骨折（VFF）没有外伤史。双能X线吸收法（DXA）期间的椎体骨折评估（VFA）可用于检测这些VFF。本研究旨在确定非髋部非椎体脆性骨折患者中未诊断出的VFF的患病率。
对英国一家大型大学医院骨折联络服务（FLS）确定的非髋部非椎体脆性骨折患者进行评估，时间为2012年1月1日至2015年9月30日。当地方案确定了那些将进行VFA的患者。收集了患者特征、骨折细节、骨矿物质密度（BMD）测量值和VFA结果的数据。
567例患者（平均（标准差）年龄，72（9.4）岁），大多数为女性（88.3%），进行了VFA作为其DXA评估的一部分。143例患者（25.2%）被确定有椎体骨折，其中57.3%有一处骨折。49.5%有椎体骨折的患者BMD测量值诊断为骨质疏松症。与没有椎体骨折的患者相比，有椎体骨折的患者平均（标准差）年龄更高；74.9（8.3）岁对70.4（9.5）岁，p<0.00。75岁及以上的患者比75岁以下的患者更有可能有多处骨折（16.3%对4%，p=0.01）。
四分之一的非髋部非椎体脆性骨折患者有未诊断出的椎体骨折。老年人更有可能有椎体骨折，并且更有可能有多处骨折。骨密度测量评估期间的VFA可以进一步帮助分层未来骨折风险。
