Category: Morphometric Measurements: (Body Composition, Vertebral Fracture Recognition, Hip Geometry)

10 - Vertebral Compression Deformities in Patients with Normal Bone Mineral Densities

Introduction: Last year our 1259 patient study showing that adding VFA to DXA identified many additional patients at increased Fracture Risk. Some patients with Normal BMD had Genant grade 2 or 3 vertebral compression deformity. Were the deformities truly acute fractures, or Normal Kyphosis of Age?

Objectives: This study attempts to determine how many of the apparent fracture deformities can be conclusively identified as acute fractures using VFA on a DXA machine. How does this compare to VFA by lateral X-ray required on patients with a high BMI? What are the implications for differentiating “fractures” from “natural kyphosis of age” on VFA by DXA machine?

The data of all 1259 patients was reassessed to identify patients with Normal BMD, and VFA diagnosis of Clinical Osteoporosis. We found complete data on 79 patients. Each of the DXA/VFA studies performed on our Hologic Discovery SL machine were carefully reviewed on 2 separate occasions to identify which ones clearly showed the acute angles of acute fractures.

Vertebral endplates were readily identified by our machine. 7 of 10 patients with grade 2 Biconcave deformities showed acute fracture angles. 49 of 53 Wedge deformities had anterior cortices unreadable on DXA machine VFA. 4 showed definite anterior cortex buckles, and none of the 3 with multiple deformities showed more than 1. 2 wedge deformities were identified by an acute buckle of an endplate. Of 7 wedge patients with high BMI requiring X-ray: 1 acute fracture, 4 anterior cortices showed remodeling, 1 no acute fracture, and 1 (significant scoliosis) unreadable. 1 biconcave patient requiring x-rays had smoothly curved endplates.

Acute fracture angle endplate deformities were easily identified in 6 of 10 biconcave patients. 92% anterior cortices were too fuzzy by DXA machine to analyze. By x-rays: 4 of 6 readable wedge deformity anterior cortices showed remodeling, 1 showed acute fracture, 1 showed no acute fracture. We can infer that the majority of wedge deformities would have shown acute or remodeling anterior cortex fracture deformities, if we had obtained lateral x-rays on all patients. These authors believe that the extra cost and radiation exposure cannot be justified. Therefore, we suggest that all wedge deformities be considered the result of fracture. We suggest that “natural kyphosis of age” be considered unrecognized fractures.>

Ann Ginther

Research Assistant
Cedar Valley Medical Specialists, PC
Waterloo, Iowa

Jay Ginther

Director, Cedar Valley Bone Health Institute of Iowa
Cedar Valley Medical Specialists, PC
Waterloo, Iowa