Vertebral Fracture Assessment by Dual X-Ray Absorptiometry: A Valid Tool to Detect Vertebral Fractures in Community-Dwelling Older Adults in a Population-Based Survey

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Domiciano, Diogo S. ^[1] ; Figueiredo, Camille P. ^[1] ; Lopes, Jaqueline B. ^[1] ; Kuroishi, Marcia E. ^[1] ; Takayama, Liliam ^[1] ; Caparbo, Valeria F. ^[1] ; Fuller, Priscila ^[1] ; Menezes, Paulo F. ^[1] ; Scazufca, Marcia ^[1] ; Bonfa, Eloisa ^[1] ; Pereira, Rosa M. R. ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, BR-01246903 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: ARTHRITIS CARE & RESEARCH; v. 65, n. 5, p. 809-815, MAY 2013.
• Citações Web of Science: 18

Resumo

Objective Vertebral fractures are associated with higher morbidity and mortality. Since 70% of vertebral fractures are clinically silent, a radiologic image of the spine has to be acquired for the diagnosis. The aim of this study was to compare the performance of Vertebral Fracture Assessment (VFA) by dual x-ray absorptiometry (DXA) with radiographs to identify vertebral fractures in community-dwelling older adults. Methods A total of 429 older adults (ages 65 years) were enrolled in this cohort. VFA by DXA measurements were evaluated by 2 expert rheumatologists by consensus, and spine radiographs were analyzed according to the semiquantitative method by an expert radiologist. The correlation between VFA and spine radiographs to identify vertebral fractures was analyzed by kappa scores. Results The prevalence of vertebral fractures in VFA and radiographs was 29.1% and 29.4%, respectively (P = 0.99). The frequency of unavailable vertebrae was significantly lower in spinal radiographs than in VFA (0.9% and 5.6%, respectively; P < 0.001), particularly in T4T6. According to VFA, 5,013 vertebrae (96%) were identified as normal and 144 (2.7%) had grade 1, 58 (1.1%) had grade 2, and 12 (0.2%) had grade 3 fractures. The sensitivity of VFA was 72.9% and the specificity was 99.1% to identify vertebral fractures. The sensitivity increased to 92% and the specificity increased to 99.9% when excluding grade 1 deformities. A good correlation between VFA and radiographs ( = 0.74) was observed, and the exclusion of grade 1 resulted in even better agreement ( = 0.84). Conclusion In community-dwelling older adults, VFA and radiographs had comparable performances in identifying vertebral fractures, particularly if mild deformities are excluded. Therefore, this methodology is a feasible and promising alternative to improve the management of patients with a high risk of osteoporotic fractures. (AU)

• Processo FAPESP: 03/09313-0 - Prevalência de osteoporose, fraturas vertebrais e não vertebrais em uma população feminina, de 65 anos ou mais na área do Butantã
• Beneficiário: Rosa Maria Rodrigues Pereira
• Modalidade de apoio: Auxílio à Pesquisa - Regular