University of Manitoba, Winnipeg, MB, Canada.
Department of Medicine, St. Boniface Hospital, Room C5121, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
Arch Osteoporos. 2020 May 3;15(1):65. doi: 10.1007/s11657-020-00735-2.
Vertebral fracture assessment (VFA) provides incremental information in identifying women and men aged 70 years and older qualifying for anti-osteoporosis treatment compared with FRAX major osteoporotic fracture (MOF) probability computed with bone mineral density (BMD).
This analysis was performed to inform appropriate use of VFA testing as part of Osteoporosis Canada's Guidelines Update, assuming vertebral fracture is an indication for pharmacotherapy in women and men.
Women and men aged 70 years and older without previous high-risk fracture (i.e., hip, spine, or multiple fractures) were identified in a BMD registry for the province of Manitoba, Canada. MOF probability with BMD was computed using the Canadian FRAX tool. VFA was performed in those with a minimum BMD T-score of -1.5 or lower.
The study population consisted of 7289 women (mean age 76.7 ± 5.6 years) and 1323 men (77.9 ± 5.8 years). More women than men qualified for VFA testing (48.7% vs 25.4%, respectively, p < 0.001). Among those undergoing VFA, a vertebral fracture was more commonly detected among men than women (22.9% vs 13.3%, p < 0.001), and vertebral fracture prevalence increased with lower BMD T-score (both p trend <0.001). The number needed to screen with VFA to detect a vertebral fracture was 8 for women and 4 for men. MOF probability was substantially lower in men than in women, and fewer men than women (3.3% vs 20.2%, p < 0.001) met a treatment threshold of MOF 20% or greater. In those with MOF probability <20%, VFA identified an incremental 5.4% of men and 3.4% of women for treatment based upon vertebral fracture.
The number needed to screen to identify a previously unappreciated vertebral fracture is low and further improves with lower BMD T-score. VFA identified more men as qualifying for treatment than MOF probability. In women, treatment qualification was predominantly from MOF probability.
本分析旨在为骨质疏松症加拿大指南更新提供信息，假设椎体骨折是女性和男性药物治疗的指征，以告知适当使用 VFA 检测。
在加拿大马尼托巴省的一个 BMD 登记处中，确定了年龄在 70 岁及以上且无既往高风险骨折（即髋部、脊柱或多处骨折）的女性和男性。使用加拿大 FRAX 工具计算 BMD 的主要骨质疏松性骨折（MOF）概率。在最低 BMD T 评分小于等于-1.5 的患者中进行 VFA。
研究人群包括 7289 名女性（平均年龄 76.7±5.6 岁）和 1323 名男性（77.9±5.8 岁）。接受 VFA 检测的女性多于男性（分别为 48.7%和 25.4%，p<0.001）。在接受 VFA 的患者中，男性椎体骨折的检出率高于女性（22.9%对 13.3%，p<0.001），且椎体骨折的发生率随 BMD T 评分的降低而增加（均 p 趋势<0.001）。使用 VFA 筛查以发现椎体骨折的人数在女性中为 8，在男性中为 4。MOF 概率在男性中明显低于女性，且符合 MOF 20%或更高治疗阈值的男性少于女性（3.3%对 20.2%，p<0.001）。在 MOF 概率<20%的患者中，VFA 确定了 5.4%的男性和 3.4%的女性需要基于椎体骨折进行治疗。
识别先前未被发现的椎体骨折的筛查人数较少，且随着 BMD T 评分的降低而进一步提高。VFA 确定了更多符合治疗条件的男性，而不是 MOF 概率。在女性中，治疗资格主要来自 MOF 概率。
