The vertebrae (bones in the spine) can gradually crumble or suddenly crunch. The resulting minor ache is often mistaken for arthritis or a pulled muscle. Gradual crumbles are “morphometric” (detected by x-ray) fractures, and just as valid as “clinical” (recognized) fractures in predicting Fracture Risk and future fractures.
Vertebral Fracture Assessment (VFA) looks at the spine from the side with a DXA machine or a standard x-ray. Each vertebra is evaluated for wedging (crunching or crumbling in the front) or biconcave deformity (from the discs punching in the center of the vertebra from top and bottom). A single vertebral deformity by 25% or more diagnoses “Clinical Osteoporosis” pre-empting DXA, BMD, and FRAX. VFA is an additional standard for assessing Fracture Risk.
VFA requires a human to look at each vertebra from T4 through L4 for deformity. VFA by DXA machine requires 2 more pictures than the 3 standard DXA pictures. VFA is a different technology from DXA and is not part of a basic DXA report. VFA is additional information that supplements DXA.
Humpback deformity in a patient is a strong hint that VFA will probably find multiple vertebral wedge compression fracture deformities. Wedge deformities can often be suspected by finding humpback (kyphosis). But multiple biconcave compression fracture deformities can hide in a patient with a straight spine. VFA is usually required to find biconcave deformities. VFA needs to be part of a Complete Bone Health Evaluation to fully assess fracture risk.
Last time we discussed DXA. Today we discussed VFA. Thursday we discuss what I discovered by combining the two in a Complete Bone Health Evaluation on every patient.
Jay Ginther, MD