If you screen by DXA alone you fail to identify most of the individuals who will fracture. Over 80% of fracture patients over age 50 have “osteopenia” or “normal” as their Bone Mineral Density (BMD) test result on DXA. Wow! DXA is a terrible stand-alone test.
Previous fractures are a much more reliable screen. Any previous fracture predicts future fractures. The best predictors of fracture risk are Vertebral (spine) fractures, but there is a problem. Most vertebral “crumble” or even “crunch” fractures are not identified as fractures until you look for them. You must do Vertebral Fracture Assessment (VFA) to identify those persons who are at increased risk of fracture because they already have fractured.
The increase in risk is huge. If you have just one undetected vertebral crumble, your fracture risk is actually 3 times what DXA told you. Three vertebral fractures increase your risk to 9 times the risk of someone the same age and DXA t-score, but without any previous fractures. Unknown vertebral fractures are common. Over 20% of women over 50 have them.
In my practice, I would miss over 1/3 of the patients with increased fracture risk (clinical osteoporosis) if I relied on DXA Alone. Saturday 5 October I am presenting Poster 341 at ASBMR (American Society for Bone & Mineral Research) summarizing what I learned by doing VFA on every patient.
Take control of your bone health. Learn your true fracture risk by adding VFA to your DXA.
Jay Ginther, MD