Nobody doubts the importance vertebral fractures have in predicting the risk for future osteoporotic fractures, most importantly hip fractures; the predictive value of vertebral fractures has been documented in numerous prospective studies around the world.
This finding has been recognized in the treatment guidelines of many clinical professional societies and independent health organizations such as the National Osteoporosis Foundation (NOF). The NOF guidelines stipulate that a vertebral fracture constitutes a diagnosis of osteoporosis, independent of bone density, and justifies treatment. The World Health Organization’s FRAX fracture risk assessment tool includes prevalent fractures, including radiographic vertebral fractures, as one of its seven clinical risk factors. In a 55 year old women, a prevalent vertebral fracture can increase the 10-year risk of another osteoporotic fracture almost two-fold (see table).
However, nobody talks about how vertebral fractures are found. Most vertebral fractures do not come to clinical attention, resulting in significant underdiagnosis and treatment of osteoporosis. This simple fact is starting to be picked up by commentators in the press. Recent editorials in the New York Times (by Jane E. Brody on June 27th, 2011) and USA Today (by Gail Sheehy on September 19th, 2011) encourage patients to ask their doctors about vertebral fractures and to ask them to perform a test that can find them.
Part of the problem currently is that there are no universally accepted standards on how to do this. Gail Sheehy refers to VFA (Vertebral Fracture Assessment) images, which are lateral spine radiographs obtained at low x-ray dose on a bone densitometer. However, VFA cannot be performed on all bone densitometers and is not universally reimbursed. When VFA is not available, conventional x-rays can serve the same purpose, and indeed, are more reliable for detecting mild vertebral fractures.
This is why we have developed SpineAnalyzer™, which physicians can use to document vertebral fractures on conventional x-rays and VFA images alike in a comprehensive, quantitative, objective and personalized way. SpineAnalyzer generates an easy-to-understand report much like a bone densitometry report, which can be shared with the patient.
It is refreshing to see a growing public awareness of osteoporosis and its consequences if left untreated, but there is still a huge amount of work to do to spread the message. Gail Sheehy refers to the NOF’s “Let’s Get Talking” campaign. We agree wholeheartedly and believe that being pro-active in finding vertebral fractures is a key part of the conversation.