Adding Lateral Spine Imaging for Vertebral Fractures to Densitometric Screening: Improving Ascertainment of Patients at High Risk of Incident Osteoporotic Fractures

Richard Prince, Joshua Lewis, W.H. Lim, Germaine Wong, Kevin E. Wilson, Benjamin Khoo, Kun Zhu, Douglas P. Kiel, John T. Schousboe

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Abstract

The current diagnosis of osteoporosis is limited to a T‐score ≤–2.5. However, asymptomatic vertebral fractures (VF) are known to predict a high risk of subsequent fractures and pharmaceutical intervention is known to reduce future fracture risk in these individuals. In a prospective, population‐based cohort of ambulant older women, we sought to evaluate the role of VF detection by screening densitometric lateral spine imaging (LSI) for VF at time of bone density testing to the effect on the magnitude of fracture risk. A total of 1084 women (mean age 75 years ± SD 3 years) had baseline LSI that identified 100 (9%) women with VFs and 89 (8%) with femoral neck (FN) T‐score osteoporosis ≤–2.5. Follow‐up identified incident clinical spine fracture in 73 (7%), 305 (28%) with any fracture‐related hospitalization, and 121 (11%) with a hip fracture–related hospitalization. Compared with those without baseline VF, in those with baseline VF, relative risk (RR) for incident clinical spine, hip, and any fracture were 3.46 (95% confidence interval [CI] 2.14–5.60, p < 0.001); 1.72 (95% CI 1.09–2.71, p = 0.02), and 1.4 (95% CI 1.07–1.84, p = 0.02), respectively. In 675 (62%) of women with femoral neck osteopenia (T‐score <–1 to >–2.5), 61 (9%) also had a VF. Compared with those without baseline VF, RR for any incident fragility fractures and fractures at spine and hip in those with baseline VF were 1.6 (95% CI 1.2–2.1, p < 0.01), 3.9 (95% CI 2.2–6.9, p < 0.01), and 1.6 (95% CI 0.9–2.8, p = 0.10), respectively. On basis of the prognosis, older women with LSI VF with osteopenia should be diagnosed with osteoporosis and should be considered for pharmaceutical intervention. © 2018 American Society for Bone and Mineral Research.
Original languageEnglish
Pages (from-to)282-289
Number of pages8
JournalJournal of Bone & Mineral Research
Volume34
Issue number2
Early online date5 Nov 2018
DOIs
Publication statusPublished - Feb 2019

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Osteoporotic Fractures
Spine
Confidence Intervals
Osteoporosis
Hip
Hospitalization
Metabolic Bone Diseases
Femur Neck
Hip Fractures
Pharmaceutical Preparations
Bone Density

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@article{c1849bc3778f4d9d9b812eb513f63b9c,
title = "Adding Lateral Spine Imaging for Vertebral Fractures to Densitometric Screening: Improving Ascertainment of Patients at High Risk of Incident Osteoporotic Fractures",
abstract = "The current diagnosis of osteoporosis is limited to a T‐score ≤–2.5. However, asymptomatic vertebral fractures (VF) are known to predict a high risk of subsequent fractures and pharmaceutical intervention is known to reduce future fracture risk in these individuals. In a prospective, population‐based cohort of ambulant older women, we sought to evaluate the role of VF detection by screening densitometric lateral spine imaging (LSI) for VF at time of bone density testing to the effect on the magnitude of fracture risk. A total of 1084 women (mean age 75 years ± SD 3 years) had baseline LSI that identified 100 (9{\%}) women with VFs and 89 (8{\%}) with femoral neck (FN) T‐score osteoporosis ≤–2.5. Follow‐up identified incident clinical spine fracture in 73 (7{\%}), 305 (28{\%}) with any fracture‐related hospitalization, and 121 (11{\%}) with a hip fracture–related hospitalization. Compared with those without baseline VF, in those with baseline VF, relative risk (RR) for incident clinical spine, hip, and any fracture were 3.46 (95{\%} confidence interval [CI] 2.14–5.60, p < 0.001); 1.72 (95{\%} CI 1.09–2.71, p = 0.02), and 1.4 (95{\%} CI 1.07–1.84, p = 0.02), respectively. In 675 (62{\%}) of women with femoral neck osteopenia (T‐score <–1 to >–2.5), 61 (9{\%}) also had a VF. Compared with those without baseline VF, RR for any incident fragility fractures and fractures at spine and hip in those with baseline VF were 1.6 (95{\%} CI 1.2–2.1, p < 0.01), 3.9 (95{\%} CI 2.2–6.9, p < 0.01), and 1.6 (95{\%} CI 0.9–2.8, p = 0.10), respectively. On basis of the prognosis, older women with LSI VF with osteopenia should be diagnosed with osteoporosis and should be considered for pharmaceutical intervention. {\circledC} 2018 American Society for Bone and Mineral Research.",
author = "Richard Prince and Joshua Lewis and W.H. Lim and Germaine Wong and Wilson, {Kevin E.} and Benjamin Khoo and Kun Zhu and Kiel, {Douglas P.} and Schousboe, {John T.}",
year = "2019",
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language = "English",
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pages = "282--289",
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T1 - Adding Lateral Spine Imaging for Vertebral Fractures to Densitometric Screening: Improving Ascertainment of Patients at High Risk of Incident Osteoporotic Fractures

AU - Prince, Richard

AU - Lewis, Joshua

AU - Lim, W.H.

AU - Wong, Germaine

AU - Wilson, Kevin E.

AU - Khoo, Benjamin

AU - Zhu, Kun

AU - Kiel, Douglas P.

AU - Schousboe, John T.

PY - 2019/2

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N2 - The current diagnosis of osteoporosis is limited to a T‐score ≤–2.5. However, asymptomatic vertebral fractures (VF) are known to predict a high risk of subsequent fractures and pharmaceutical intervention is known to reduce future fracture risk in these individuals. In a prospective, population‐based cohort of ambulant older women, we sought to evaluate the role of VF detection by screening densitometric lateral spine imaging (LSI) for VF at time of bone density testing to the effect on the magnitude of fracture risk. A total of 1084 women (mean age 75 years ± SD 3 years) had baseline LSI that identified 100 (9%) women with VFs and 89 (8%) with femoral neck (FN) T‐score osteoporosis ≤–2.5. Follow‐up identified incident clinical spine fracture in 73 (7%), 305 (28%) with any fracture‐related hospitalization, and 121 (11%) with a hip fracture–related hospitalization. Compared with those without baseline VF, in those with baseline VF, relative risk (RR) for incident clinical spine, hip, and any fracture were 3.46 (95% confidence interval [CI] 2.14–5.60, p < 0.001); 1.72 (95% CI 1.09–2.71, p = 0.02), and 1.4 (95% CI 1.07–1.84, p = 0.02), respectively. In 675 (62%) of women with femoral neck osteopenia (T‐score <–1 to >–2.5), 61 (9%) also had a VF. Compared with those without baseline VF, RR for any incident fragility fractures and fractures at spine and hip in those with baseline VF were 1.6 (95% CI 1.2–2.1, p < 0.01), 3.9 (95% CI 2.2–6.9, p < 0.01), and 1.6 (95% CI 0.9–2.8, p = 0.10), respectively. On basis of the prognosis, older women with LSI VF with osteopenia should be diagnosed with osteoporosis and should be considered for pharmaceutical intervention. © 2018 American Society for Bone and Mineral Research.

AB - The current diagnosis of osteoporosis is limited to a T‐score ≤–2.5. However, asymptomatic vertebral fractures (VF) are known to predict a high risk of subsequent fractures and pharmaceutical intervention is known to reduce future fracture risk in these individuals. In a prospective, population‐based cohort of ambulant older women, we sought to evaluate the role of VF detection by screening densitometric lateral spine imaging (LSI) for VF at time of bone density testing to the effect on the magnitude of fracture risk. A total of 1084 women (mean age 75 years ± SD 3 years) had baseline LSI that identified 100 (9%) women with VFs and 89 (8%) with femoral neck (FN) T‐score osteoporosis ≤–2.5. Follow‐up identified incident clinical spine fracture in 73 (7%), 305 (28%) with any fracture‐related hospitalization, and 121 (11%) with a hip fracture–related hospitalization. Compared with those without baseline VF, in those with baseline VF, relative risk (RR) for incident clinical spine, hip, and any fracture were 3.46 (95% confidence interval [CI] 2.14–5.60, p < 0.001); 1.72 (95% CI 1.09–2.71, p = 0.02), and 1.4 (95% CI 1.07–1.84, p = 0.02), respectively. In 675 (62%) of women with femoral neck osteopenia (T‐score <–1 to >–2.5), 61 (9%) also had a VF. Compared with those without baseline VF, RR for any incident fragility fractures and fractures at spine and hip in those with baseline VF were 1.6 (95% CI 1.2–2.1, p < 0.01), 3.9 (95% CI 2.2–6.9, p < 0.01), and 1.6 (95% CI 0.9–2.8, p = 0.10), respectively. On basis of the prognosis, older women with LSI VF with osteopenia should be diagnosed with osteoporosis and should be considered for pharmaceutical intervention. © 2018 American Society for Bone and Mineral Research.

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DO - 10.1002/jbmr.3595

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