Vertebral fracture assessment useful predictor of osteoporosis in postmenopausal women

Bangkok, Thailand: Tanawat Amphansap et al conducted a study to compare bone mineral density (BMD) in Thai postmenopausal women with and without distal radius fracture, and to investigate the role of vertebral fracture assessment (VFA) in diagnosing osteoporosis after distal radius fracture.

The cross-sectional study was conducted in Thai postmenopausal women with and without distal radius fracture.

The researchers found that vertebral fracture assessment helped diagnose osteoporosis in postmenopausal women in both fracture and non-fracture groups.

A venous blood specimen was obtained and sent for complete blood count (CBC), blood urea nitrogen (BUN), serum creatinine (Cr), calcium, phosphate, albumin, total alkaline phosphatase, 25-hydroxy vitamin D level, and intact parathyroid hormone level 2 weeks after the fracture occurred. The BMD T-scores of the femoral neck (FN), total hip (TH) and lumbar spine (LS) were obtained from dual energy X-ray absorptiometry (DXA) scan performed within 2 weeks of fracture with reference values adapted for the Thai population. All measurements were done in accordance with the recommendations from the International Society for Clinical Densitometry (ISCD) by a single certified densitometer technologist. The DXA was calibrated by the manufacturer and daily quality check was performed.

The technologist regularly performed an in vivo precision assessment. VFA was also performed in the same session, using the same DXA model. A vertebral compression fracture (VCF) was defined as a collapse of more than 25% of vertebral body height. When scoliosis was present, an X-ray of the spine was requested to detect VCF.

BMD were compared between groups. Participants were classified into osteoporosis, osteopenia or normal using BMD alone, and BMD plus VFA, where a mere presence of vertebral compression fracture indicated osteoporosis.

It was found that

• Fifty postmenopausal women with distal radius fractures and 111 non-fracture postmenopausal women participated in the study.

•The mean BMD was significantly lower at all sites in the fracture group (FN BMD 0.590 ± 0.075 vs 0.671 ± 0.090, p ¼ 0.007; TH BMD 0.742 ± 0.103 vs 0.828 ± 0.116, P ¼ 0.009; LS BMD 0.799 ± 0.107 vs 0.890 ± 0.111, P ¼ 0.009 in the fracture vs non-fracture group respectively).

• Among 50 postmenopausal women in the fracture group, there were 16 (32%) osteoporosis, 32 (64%) osteopenia, and 2 (4%) normal patients. In the non-fracture group, 7 (6.31%), 69 (62.16%), and 35 (31.53%) were classified as osteoporosis, osteopenia, and normal, respectively

• VFA increased the prevalence of osteoporosis from 16 (32%) to 23 (46%) in the fracture group, and 7 (6.31%) to 17 (16.22%) in the non-fracture group, with a number needed to treat 9.

The authors concluded that - Postmenopausal women with distal radius fractures had lower BMD. Incorporating VFA into diagnosis of osteoporosis increased the prevalence of osteoporosis in both fracture and non-fracture groups. Postmenopausal women aged 50 years or older with distal radius fracture are a good target for the investigation of osteoporosis.

Further reading:

Comparison of bone mineral density and vertebral fracture assessment in postmenopausal women with and without distal radius fractures

Tanawat Amphansap, Chayaphong Rattanaphonglekha, Jaruwat Vechasilp, Nitirat Stitkitti, Kamonchalat Apiromyanont, Atiporn Therdyothin.

Osteoporosis and Sarcopenia 7 (2021) 134- 139

https://doi.org/10.1016/j.afos.2021.11.004