From the Guidelines
A DEXA scan can detect a vertebral compression fracture, particularly with the use of Vertebral Fracture Assessment (VFA), a feature available on many modern DEXA machines. While DEXA scans are primarily used to measure bone mineral density and diagnose osteoporosis, they can incidentally detect vertebral compression fractures, particularly in the spine 1. The VFA feature provides a lateral thoracic and lumbar spine image from T5 to L5, allowing for the detection of vertebral body deformities, with most vertebral fractures occurring between the T7 and L4 levels 1.
Key Points to Consider
- VFA is a complementary feature to DXA, providing a point-of-care service for detecting vertebral body deformities 1.
- A semiquantitative visual method is used for diagnosis, characterizing the morphology based on shape and location, as well as the total number of involved vertebrae 1.
- Grade 2 and grade 3 fractures are more predictive of future fractures than grade 1 fractures, which have a greater overlap with nonfracture deformities 1.
- The utility of VFA is in identifying patients who would not otherwise qualify for treatment under the guidelines of the NOF, which are based solely on BMD measurements 1.
Clinical Implications
- The detection of vertebral compression fractures using VFA can influence initiating therapy in asymptomatic patients, as well as guide therapeutic decisions in treated patients 1.
- If a compression fracture is suspected, a doctor may order conventional X-rays, CT scans, or MRI for confirmation and to assess the severity and age of the fracture 1.
- DEXA's main advantage is its low radiation dose compared to CT scans, but its primary purpose remains bone density measurement rather than fracture detection 1.
From the Research
Detection of Vertebral Compression Fractures using DEXA Scans
- A DEXA scan can detect vertebral compression fractures, as it measures bone mineral density (BMD) and can assess the presence of vertebral fractures 2.
- The supine lateral spine DEXA measurement has been shown to correlate well with vertebral compression fractures (VCF) 3.
- Vertebral fracture assessment (VFA) is a low-radiation-dose method that can be used with DEXA scans to detect thoracic and lumbar vertebral fractures, and has a good negative predictive value 2.
- DEXA scans are considered the gold standard for measuring BMD and can be used to diagnose osteoporosis, which is a risk factor for vertebral compression fractures 4, 5.
Factors Affecting Detection
- The sensitivity of DEXA scans in detecting osteoporosis and vertebral compression fractures can vary depending on the measurement site and technique used 3, 6.
- The use of advanced imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), can also be used to measure BMD and predict postoperative outcomes, including the risk of vertebral compression fractures 6.
- The trabecular bone score (TBS) is a texture parameter that can be measured using DEXA scans and has been shown to correlate with 3D bone microarchitecture parameters and fracture risk 2.