Routine versus targeted vertebral fracture assessment for the detection of vertebral fractures

Osteoporos Int. 2008 Aug;19(8):1167-73. doi: 10.1007/s00198-007-0548-0. Epub 2008 Mar 13.


Fracture risk is underestimated in women with unknown vertebral fractures. Using VFA, we compared two screening methods: targeted (6,388 women) and routine (2,176 women). Routine screening detected fractures in 20%. Targeted screening only required 5% attending for DXA to undergo VFA but only detected 9.6% of women with fractures.

Introduction: BMD alone underestimates fracture risk in women with unknown vertebral fractures. We report the results of routine vertebral fracture assessment (VFA) screening and compare with targeted screening.

Method: Our centre initially targeted VFA at women with reasons to suspect a vertebral fracture. Later we changed to routine VFA screening for all women over 65. We retrospectively compare each screening method's ability to detect vertebral fractures.

Results: Six thousand three hundred and eighty-eight women over 65 underwent DXA during the period of targeted VFA and 2,176 during routine VFA. Routine VFA detected 420 (20.0%) women with fracture. Most vertebral fractures (56.2%) occurred in women with osteopenia. Routine VFA would be expected to alter the management of 1 in 6 osteopenic women. Targeted VFA was performed in 332 (5.2%) women detecting 122 (1.9%) women with fractures. It was estimated that targeted VFA only detected 9.6% of women with a vertebral fracture. Targeted VFA failed to detect fractures in 18.1% of the population attending for DXA and in 29% of those with osteoporosis.

Conclusion: Routine VFA detects vertebral fractures in 20% of women over 65. Targeted VFA greatly reduces the number of VFAs performed but only detects a minority of the women with vertebral fractures.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Absorptiometry, Photon
  • Aged
  • Aged, 80 and over
  • Bone Density
  • Bone Diseases, Metabolic / complications
  • Bone Diseases, Metabolic / diagnosis
  • Bone Diseases, Metabolic / epidemiology
  • England / epidemiology
  • Female
  • Humans
  • Mass Screening / methods
  • Osteoporosis, Postmenopausal / complications
  • Osteoporosis, Postmenopausal / diagnosis
  • Osteoporosis, Postmenopausal / epidemiology
  • Patient Selection
  • Retrospective Studies
  • Spinal Fractures / diagnosis*
  • Spinal Fractures / epidemiology
  • Spinal Fractures / etiology