Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN, USA; University of Minnesota, Minneapolis, MN, USA.
University of Manitoba, Winnipeg, Canada.
Bone. 2019 Apr;121:72-79. doi: 10.1016/j.bone.2019.01.009. Epub 2019 Jan 8.
The predictive validity of vertebral fracture assessment (VFA) on bone density lateral spine images to identify prevalent vertebral fractures in routine clinical practice has not been established. Our objective was to estimate the associations of prevalent vertebral fracture identified on VFA images in routine practice with incident hip, all non-vertebral, major osteoporotic, and clinical vertebral fractures, using the Manitoba Bone Density database.
From 2010 onward, 9972 men and women (mean age [SD] 76 [6.9] years) had VFA images obtained at the time of bone densitometry that were interpreted for vertebral fracture by the clinicians reading the bone density tests. Definite and possible prevalent vertebral fractures, respectively, were identified in 1575 (15.8%) and 293 (2.9%) using a modified Algorithm Based Qualitative method. We ascertained incident fractures using Manitoba provincial health databases over a mean 2.8 (SD 1.7) years and used Cox proportional hazards models to estimate the associations of prevalent vertebral fractures with incident fractures.
Compared to no prevalent vertebral fracture, those with definite prevalent vertebral fracture had higher hazard ratios for incident hip (HR 1.95, 95% C.I. 1.45 to 2.62), non-vertebral (HR 1.99, 95% C.I. 1.68 to 2.35), and clinical vertebral fracture (HR 2.68, 95% C.I. 1.69 to 4.23) adjusted for age, bone mineral density, body mass index, prior fracture, parental hip fracture, glucocorticoid use, alcohol use, smoking, and rheumatoid arthritis. These associations did not vary by FRAX fracture risk estimates or bone mineral density category.
Prevalent vertebral fractures identified on densitometric VFA images in routine clinical practice are strongly associated with incident fractures, and this study is the first to show this using any lateral spine imaging modality outside of research settings. These findings are strong evidence supporting the targeted use of densitometric VFA imaging among post-menopausal women and older men referred for bone densitometry.
在常规临床实践中，基于椎体骨折评估（VFA）的骨密度侧位脊柱图像预测现有椎体骨折的能力尚未得到证实。我们的目的是利用曼尼托巴骨密度数据库，评估常规临床实践中 VFA 图像上识别出的现有椎体骨折与髋部、所有非椎体、主要骨质疏松性和临床椎体骨折的发生之间的关联。
自 2010 年以来，9972 名男性和女性（平均年龄[标准差]76[6.9]岁）在进行骨密度检测时同时进行了 VFA 图像检查，由解读骨密度检测的临床医生对 VFA 图像进行椎体骨折的解读。采用改良的基于算法的定性方法，分别确定了 1575 例（15.8%）和 293 例（2.9%）明确和可能的现有椎体骨折。通过曼尼托巴省卫生数据库平均 2.8（标准差 1.7）年的随访，确定了新发骨折情况，并使用 Cox 比例风险模型来估计现有椎体骨折与新发骨折之间的关联。
与没有现有椎体骨折相比，明确有现有椎体骨折的患者发生髋部（危险比 1.95，95%置信区间 1.45 至 2.62）、非椎体（危险比 1.99，95%置信区间 1.68 至 2.35）和临床椎体（危险比 2.68，95%置信区间 1.69 至 4.23）骨折的风险更高，这些风险比经年龄、骨密度、体重指数、既往骨折、父母髋部骨折、糖皮质激素使用、酒精使用、吸烟和类风湿关节炎校正后仍有统计学意义。这些关联在基于 FRAX 骨折风险评估或骨密度分类的情况下没有差异。
在常规临床实践中通过骨密度 VFA 图像识别的现有椎体骨折与新发骨折密切相关，本研究首次使用任何研究以外的侧位脊柱成像方式证明了这一点。这些发现为在接受骨密度检测的绝经后妇女和老年男性中针对性地使用骨密度 VFA 成像提供了有力证据。
