Park Nicollet Osteoporosis Center, Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN, USA.
Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
J Bone Miner Res. 2019 Dec;34(12):2205-2212. doi: 10.1002/jbmr.3836. Epub 2019 Sep 10.
The impact of vertebral fracture assessment (VFA) on lateral spine images in clinical practice on subsequent patient use of fracture prevention medication is unknown. Our objective was to determine the association of prevalent vertebral fracture identified on bone density lateral spine images (positive VFA) with subsequent use of fracture prevention therapy in usual clinical practice, using the Manitoba Bone Density Program database prospective observational cohort. Since 2010, targeted VFA imaging has been done at the time of bone densitometry in Manitoba for 21% of women and men meeting criteria based on age, bone mineral density (BMD), height loss, and glucocorticoid use. Among 6652 treatment-naive individuals with at least 90 days follow-up who had VFA imaging, 923 (13.9%) had one or more definite vertebral fractures identified using a modified algorithm-based qualitative (ABQ) method. For those with a positive VFA, their bone density reports stated the patient was at high risk of subsequent fracture and qualified for fracture prevention therapy. Subsequent osteoporosis treatment initiated within the next 12 months was identified using population-based pharmacy data. Logistic regression models were used to estimate the association of positive VFA with subsequent prescription (Rx), compared to negative VFA. Fracture prevention medication was started by 2127 (32%) individuals, 52.3% with positive versus 28.4% with negative VFA (p value <0.001). This association was substantially stronger in those designated (before VFA results were known) to have low or moderate fracture risk compared to high fracture risk (interaction p value <0.001), and in those with osteopenia (OR 4.51; 95% CI, 3.48 to 5.85) compared to those with osteoporosis by BMD criteria (OR 1.72; 95% CI, 1.43 to 2.08, interaction p value <0.001). Targeted VFA imaging at the time of bone densitometry substantially improves identification of those at high fracture risk and fracture prevention medication use among those with prevalent vertebral fracture. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.
在临床实践中，椎体骨折评估（VFA）对侧位脊柱图像的影响是否会影响随后患者使用骨折预防药物尚不清楚。我们的目的是使用曼尼托巴骨密度计划数据库前瞻性观察队列，确定在常规临床实践中，基于年龄、骨密度（BMD）、身高损失和糖皮质激素使用等标准，在骨密度侧位脊柱图像上发现的现患椎体骨折（阳性 VFA）与随后使用骨折预防治疗之间的关系。自 2010 年以来，在曼尼托巴，对于符合标准的 21%的女性和男性，在进行骨密度检测时，会进行有针对性的 VFA 成像。这些标准基于年龄、骨密度（BMD）、身高损失和糖皮质激素使用等。在 6652 名至少有 90 天随访且接受过 VFA 成像的未经治疗的个体中，923 名（13.9%）使用改良基于算法的定性（ABQ）方法确定了一个或多个明确的椎体骨折。对于 VFA 阳性的患者，他们的骨密度报告指出患者有发生后续骨折的高风险，并符合骨折预防治疗的条件。在接下来的 12 个月内，通过人群为基础的药房数据确定后续开始的骨质疏松治疗。使用逻辑回归模型估计阳性 VFA 与随后处方（Rx）的关联，与阴性 VFA 相比。2127 名（32%）个体开始使用骨折预防药物，阳性 VFA 患者的比例为 52.3%，而阴性 VFA 患者的比例为 28.4%（p 值<0.001）。与高骨折风险相比，在 VFA 结果未知时被指定为低或中度骨折风险的个体（交互 p 值<0.001）和在骨密度标准下被诊断为骨量减少的个体（OR 4.51；95%CI，3.48 至 5.85）与骨质疏松症相比，这种关联要强得多（OR 1.72；95%CI，1.43 至 2.08，交互 p 值<0.001）。在骨密度检测时进行有针对性的 VFA 成像，可以大大提高对高骨折风险人群的识别能力，并提高现患椎体骨折患者中骨折预防药物的使用。
