THE IMPLEMENTATION OF A VERTEBRAL FRACTURE ASSESSMENT PROTOCOL TO IMPROVE THE MANAGEMENT OF PATIENTS ATTENDING FOR ROUTINE DUAL ENERGY X-RAY ABSORPTIOMETRY

Gould, Kerrie; Malpass, Timothy; Tian-Clarke, Mei; Nesham, Ann; Dale, Nicola; Twemlow, Annette; Paskins, Zoe

Abstract

Background: Vertebral fractures are the most common osteoporotic
fracture in patients over the age of 60 and are associated with reduced quality of life, chronic pain and premature death. They are often undiagnosed and may occur in patients who have normal/osteopaenic BMD readings. As FRAX is calculated using femoral neck BMD scores, some patients with spinal osteoporosis and undiagnosed vertebral fractures may not meet the threshold for fracture prevention treatment.
Objective: To evaluate whether using vertebral fracture assessment (VFA) in patients with spinal osteoporosis who do not meet the treatment threshold, changes treatment recommendations and/or
treatment given.

Methods: A protocol was developed to perform a VFA in patients referred for first DXA with T-score <-2.5 at the spine, T-score >-2.5 at the femoral neck and a FRAX score <10%. VFAs are reported by Bone
Density Technician and Consultant Rheumatologist indicating presence, absence or suspicion of vertebral fracture. All patients who had a VFA between March 2017 and February 2018 were followed up using the electronic health record and medical GP prescribing records to identify if fracture prevention treatment had been commenced.

Results: 73 VFAs performed between March 2017 and February 2018. 25 reported as having a vertebral fracture, 43 normal and 5 uninterpretable. Of the 25 patients with vertebral fractures, 12 (48%) had been commenced on treatment, 5 (20%) had been referred to the osteoporosis service for injectable treatment, 7 (28%) not on treatment and 1 had died. Discussion: VFA changed treatment recommendations in
25/73 34% of cases and changed the ultimate treatment in 17/73 (23%) of cases. However, more work is needed with primary care colleagues to reduce the proportion of untreated patients with identified vertebral fractures. Further improvements could be made by implementing a follow-up service to ensure GPs act on the treatment recommendations.

Conclusion: VFA in patients with spinal osteoporosis whose fracture risk does not cross the NOGG treatment threshold is an effective way of identifying subclinical vertebral fractures and patients at high fracture risk in need of treatment.

Citation

Gould, K., Malpass, T., Tian-Clarke, M., Nesham, A., Dale, N., Twemlow, A., & Paskins, Z. (2018, December). THE IMPLEMENTATION OF A VERTEBRAL FRACTURE ASSESSMENT PROTOCOL TO IMPROVE THE MANAGEMENT OF PATIENTS ATTENDING FOR ROUTINE DUAL ENERGY X-RAY ABSORPTIOMETRY. Poster presented at Osteoporosis Conference 2018, Birmingham, UK

• Presentation Conference Type: Poster
• Conference Name: Osteoporosis Conference 2018
• Conference Location: Birmingham, UK
• Start Date: Dec 2, 2018
• End Date: Dec 4, 2018
• Deposit Date: Jun 28, 2023
• Publisher URL: https://link.springer.com/article/10.1007/s00198-018-4738-8
• Additional Information: Conference information;; https://link.springer.com/journal/198/volumes-and-issues/29-2/supplement