I have been a Certified Clinical Densitometrist for 4 years. Before that I read spine and hip x-rays for 30+ years as an orthopedic surgeon. Now I know that I was missing 15-20% of the patients with osteoporosis when I read DXA alone.
Last year I obtained Supine Lateral VFA capability. The patient lies supine on the table and the machine rotates to the lateral position. This is so much easier on the patient and staff than having to roll the patient on their side and trying for a true lateral. You get a good view the first try and it is so much more accurate than Granny squirming while lying on her sore shoulder.
Before I would get lateral spine x-rays on every patient with clinically apparent kyphosis. Almost every one had at least one Genant Grade 2 or 3 Vertebral Compression Deformity. Now I know that 40 years of examining patients’ spines had not taught me how to clinically pick up every morphometric vertebral deformity.
Now I obtain a lateral VFA on every patient. I diagnose Osteoporosis based on DXA and VFA together. More than 15% of the time I cannot confirm Osteoporosis by DXA alone due to arthritis in the spine or other factors. By obtaining VFA every time I no longer miss patients whose high risk for future fracture needs to be addressed.
As a society we need to place more emphasis on VFA. Missing the diagnosis by skipping VFA is not acceptable.
Jay Ginther, MD, CCD