Diagnostic Approach: Vertebral Fracture Assessments. Vertebral Fracture Assessments.

Vertebral fractures (VF) are a special group of fractures, both in men and in women. Identifying VF is clinically relevant. It provides a means to identify patients who have a high subsequent fracture risk, independent of other risks, and helps to identify patients who are likely to benefit most from drug treatment to reduce subsequent fracture risk. The standard approach for assessment of VF is a lateral radiographic view of the vertebrae, but VF can now also be diagnosed using dual-energy photon absorptiometry (DXA). However, even when optimal x-rays are available, many VF are missed. The assessment of VF is hampered by the lack of a gold standard for the definition of a VF, which varies between studies in the literature. When an abnormality in the shape or deformation of a vertebra is found, the question arises to what degree this indicates the presence of a true osteoporosis-related fracture or whether it is the result of normal variations in vertebral height or other conditions. This chapter reviews the clinical relevance of recognizing VF, the methods to measure VF (with emphasis on x-ray and DXA), the definitions of VF, differential diagnosis and the clinical applicability of spine imaging for diagnosing VFs. It reports on available data in men but, for some technical aspects of assessments, it specifies when data are only available in women. © 2010 Copyright