CLINICIAN’S GUIDE TO PREVENTION AND TREATMENT OF OSTEOPOROSIS

A vertebral fracture is consistent with a diagnosis of osteoporosis, even in the absence of a
bone density diagnosis, and is an indication for pharmacologic treatment with osteoporosis
medication to reduce fracture risk. Most vertebral fractures are asymptomatic when they first
occur and often are undiagnosed for many years. Proactive vertebral imaging is the only way to
diagnose these fractures. The finding of a previously unrecognized vertebral fracture may
change the diagnostic classification, alters future fracture risk and subsequent treatment
decisions.

Independent of BMD, age and other clinical risk factors, radiographically confirmed vertebral
fractures (even if completely asymptomatic) are a sign of impaired bone quality and strength,
and a strong predictor of new vertebral and other fractures. The presence of a single vertebral
fracture increases the risk of subsequent fractures 5-fold and the risk of hip and other fractures
2- to 3- fold. Vertebral imaging can be performed using a lateral thoracic and lumbar spine x-ray
or by lateral vertebral fracture assessment (VFA), available on most modern DXA machines.

VFA can be conveniently performed at the time of BMD assessment, while conventional x-ray
may require referral to another facility.


Indications for Vertebral Imaging
CLINICIAN’S GUIDE TO PREVENTION AND TREATMENT OF OSTEOPOROSIS




Because vertebral fractures are so prevalent in older individuals and most produce no acute
symptoms, vertebral imaging tests are recommended for the individuals defined in Table 8.
Once a first vertebral imaging test is done, it need only be repeated if prospective height loss is
documented or new back pain or postural change occurs.