A new position paper published in the journal Osteoporosis International by the International Osteoporosis Foundation (IOF) fracture working group, which urges for the routine use of vertebral fracture assessment (VFA) within post-fracture care coordination programmes such as fracture liaison services (FLS).
According to the IOF, VFA is a tool available on modern dual-energy X-ray absorptiometry (DXA) scanners which allows the detection of previous vertebral fractures by providing a lateral view of the spine during a regular DXA bone mineral density measurement of the hip and spine.
Willem Lems (Amsterdam University Medical Center, Amsterdam, The Netherlands), lead author of the position paper, states: “Vertebral fractures are independent risk factors for future vertebral and non-vertebral fractures. Yet the majority occur without the signs and symptoms of an acute fracture, and they often remain undetected. Routine use of VFA technology would allow fracture liaison services to detect more undiagnosed vertebral fractures and to identify, assess and monitor more high-risk patients in need of treatment.”
The IOF report that VFA detection of occult vertebral fractures in the FLS offers a valuable opportunity to further refine fracture risk assessment and to tailor treatment accordingly. The foundation further adds that awareness of baseline vertebral fractures facilitates definition of true new vertebral fracture events occurring during anti-osteoporosis treatment, and therefore enhances optimal monitoring and informs decisions regarding adjustment therapy.
Authors of this paper conclude by proposing that DXA-VFA be performed in all patients visiting an FLS.
Nicholas Harvey (University of Southampton, Southampton, UK), co-author and chair of the IOF Committee of Scientific Advisors, notes: “This position paper, the result of the close international collaboration between colleagues in the IOF Fracture Working Group and the MRC Lifecourse Epidemiology Unit, University of Southampton, documents the substantial potential for the improved detection of vertebral fractures within fracture liaison services. The findings are perfectly synergistic with recent guidelines from IOF and ESCEO (The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases) which set out a personalised medicine approach to treatment based on level of fracture risk. VFA thus offers a useful tool in the FLS with which to further characterise risk and so select the most appropriate treatment for an individual patient.”