This article is more than 5 years old. Information may no longer be current.
Vertebral fracture assessment improves initiation of osteoporosis therapies
Click Here to Manage Email Alerts
Identifying prevalent vertebral fractures on lateral spine images at the time of a bone density test influenced the subsequent use of osteoporosis therapies among patients, with the greatest impact observed among patients without osteoporosis by bone mineral density criteria, according to findings published in the Journal of Bone and Mineral Research.
“A practical program of targeted vertebral fracture assessment at the time of bone densitometry can increase appropriate use of fracture prevention medication among older men and women at high risk for fracture,” John T. Schousboe, MD, PhD, director of Park Nicollet Clinic Osteoporosis Services and a research investigator with HealthPartners Institute in Bloomington, Minnesota, told Endocrine Today. “At a time when the use of fracture prevention medication among those at high risk for fracture is declining, targeted use of vertebral fracture assessment can be a part of a larger strategy to reverse that trend.”
Schousboe and colleagues analyzed data from 6,652 adults aged at least 50 years registered with Manitoba Health who underwent BMD assessment via DXA of the hip and lumbar spine between February 2010 and March 2016. Patients had vertebral fracture assessment (VFA) imaging performed at the time of the DXA scan (92% women). Patients were treatment-naive and had at least 90 days of observation, according to researchers. Researchers linked participant data with data in the provincial pharmacy claims database to assess initiation of osteoporosis therapies within 12 months of the index DXA screening and VFA imaging. Logistic regression analysis was used to estimate the association between positive VFA and uncertain VFA with subsequent treatment compared with negative VFA.
Within the cohort, 923 adults (13.9%) had one or more vertebral fractures identified using a modified algorithm-based qualitative method, 204 had one or more uncertain fractures (3.1%) and 5,525 had no vertebral fractures (83.1%), according to researchers. Compared with those with a negative VFA, researchers observed that those with a positive VFA were older, had a lower BMD at all skeletal sites, had higher estimated 10-year risks for major osteoporotic and hip fractures by FRAX, were more likely to be men and were more likely to have had a prior fracture.
In unadjusted analyses, patients with a positive VFA were nearly three times as likely to initiate antiosteoporosis medication vs. those with a negative VFA (OR = 2.77; 95% CI, 2.4-3.19). Results changed little with adjustment for Fracture Risk Assessment Tool (FRAX) as a continuous measure (OR = 2.37; 95% CI, 2.04-2.75), FRAX risk category (OR = 2.41; 95% CI, 2.08-2.8) or BMD T-score category (OR= 2.38; 95% CI, 2.03-2.79), the researchers wrote.
Researchers also found that a positive VFA was most strongly associated with subsequent fracture-prevention medication use in those with osteopenia and with a FRAX 10-year estimated major osteoporotic fracture risk greater than 20%, or before their vertebral fracture status is known.
"This is particularly important, since individuals in these subsets are often unrecognized as being at high fracture risk and currently are generally untreated, Schousboe said.
Researchers found that the absolute increase in percentages prescribed medication in those with a positive compared to a negative VFA was 25.9% for those with FRAX 10-year risk of less than 10%, 25.2% for those with FRAX 10-year risk of 10% to 20%, and 9.1% for those with FRAX 10-year risk of at least 20%.
“These data lend support to targeted use of VFA for older men and postmenopausal women referred for bone densitometry, strongly suggesting that this practice would help address declining rates of fracture prevention therapy amongst those at high risk of future fractures,” they wrote. – by Regina Schaffer
For more information:
John T. Schousboe, MD, PhD, can be reached at HealthPartners Institute, 3311 Old Shakopee Road, Bloomington, MN 55425; email: scho0600@umn.edu.
Disclosures: One of the authors reports she has received research grants from Amgen and Merck paid to her institution. Schousboe reports no relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts