Making VFA Part of Standard Clinical DXA Assessment for Osteoporosis Care

Fracture risk is strongly dependent on the presence of previous fractures, especially vertebral. In this paper, we focus on the use of vertebral fracture assessment (VFA) with dual-energy x-ray absorptiometry (DXA), as vertebral fractures can be clinically silent, and their identification is critical for optimal bone health management. Our tool was to inform health care professionals about the clinical utility of accurate recognition and classification of vertebral fractures. A comprehensive narrative review was conducted on the clinical relevance of diagnosing vertebral fractures, the technical aspects of optimal methodology for VFA, image interpretation and scoring methods, and pitfalls in evaluating VFA. Proposals for standardization on methodology and indications for VFA were discussed and iterated after comments from 15 international societies to achieve consensus recommendations. Vertebral fracture assessment should ideally be performed in all patients in whom a DXA-bone mineral density measurement is indicated. However, when there are limitations to DXA access or reimbursement, VFA should be obtained in patients at high risk for fractures, such as those with a low bone mineral density T-score (<-1.0) and one or more of the following: oral glucocorticoid use, prior vertebral fracture, loss of height, and advanced age (International Society for Clinical Densitometry criteria). If VFA is not available on the DXA system software, conventional lateral spine radiographs can also be used as an alternative option to identify vertebral fractures. Although several scoring systems exist, the semiquantitative Genant score and the algorithm-based qualitative scoring system seem to be among the best, with the Genant score being the easiest to apply in clinical practice.

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Journal
Mayo Clinic Proceedings
Published
2025-12-01
DOI
https://doi.org/10.1016/j.mayocp.2025.08.005
Primary Topic
Bone health and osteoporosis research
Type
article
Field-Weighted Citation Impact
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article

Making VFA Part of Standard Clinical DXA Assessment for Osteoporosis Care

Riemer H. J. A. Slart, Kate Anna Ward, Juliet Compston, Marija Punda et al.
Mayo Clinic Proceedings
Bone health and osteoporosis research
article

Making VFA Part of Standard Clinical DXA Assessment for Osteoporosis Care

Riemer H. J. A. Slart, Kate Anna Ward, Juliet Compston, Marija Punda, John Carey, Nicholas C. Harvey, David Koff, Aliya Khan, Linda Probyn, Willem F. Lems, Kendall F. Moseley, René Rizzoli, Pauline M. Camacho, Paola Anna Erba, Klaus Engelke, Sarah Morgan, E. Michael Lewiecki, Bradford J. Richmond, John T Schousboe, Dalal S Ali, Christopher O’Brien, Oliver Bock
article en

Abstract

Fracture risk is strongly dependent on the presence of previous fractures, especially vertebral. In this paper, we focus on the use of vertebral fracture assessment (VFA) with dual-energy x-ray absorptiometry (DXA), as vertebral fractures can be clinically silent, and their identification is critical for optimal bone health management. Our tool was to inform health care professionals about the clinical utility of accurate recognition and classification of vertebral fractures. A comprehensive narrative review was conducted on the clinical relevance of diagnosing vertebral fractures, the technical aspects of optimal methodology for VFA, image interpretation and scoring methods, and pitfalls in evaluating VFA. Proposals for standardization on methodology and indications for VFA were discussed and iterated after comments from 15 international societies to achieve consensus recommendations. Vertebral fracture assessment should ideally be performed in all patients in whom a DXA-bone mineral density measurement is indicated. However, when there are limitations to DXA access or reimbursement, VFA should be obtained in patients at high risk for fractures, such as those with a low bone mineral density T-score (<-1.0) and one or more of the following: oral glucocorticoid use, prior vertebral fracture, loss of height, and advanced age (International Society for Clinical Densitometry criteria). If VFA is not available on the DXA system software, conventional lateral spine radiographs can also be used as an alternative option to identify vertebral fractures. Although several scoring systems exist, the semiquantitative Genant score and the algorithm-based qualitative scoring system seem to be among the best, with the Genant score being the easiest to apply in clinical practice.

Mayo Clinic ProceedingsVol. 100(12)
Loyola University Medical Center (US), Cleveland Clinic (US), Sunnybrook Health Science Centre (CA), University Medical Center Groningen (NL), University Hospital Centre Zagreb (HR), Johns Hopkins University (US), University of Toronto (CA), Ollscoil na Gaillimhe – University of Galway (IE), University Hospital of Bern (CH), McMaster University Medical Centre (CA), Health Sciences Centre (CA), University Hospital Southampton NHS Foundation Trust (GB), University of Alabama at Birmingham (US), Universitätsklinikum Erlangen (DE), New Mexico Clinical Research & Osteoporosis Center (US), University Hospital of Geneva (CH), NIHR Southampton Biomedical Research Centre (GB), Park Nicollet Clinic (US), Brantford Energy (Canada) (CA), Clinical Science Institute (US), HealthPartners (US), University of Milano-Bicocca (IT), McMaster University (CA)
Openalex Percentile: Top 53%
Bone health and osteoporosis research
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