Endocrine Abstracts

Background and aims: Vertebral fractures are the most common type of osteoporotic fracture but approximately three quarters remain undiagnosed. Densitometric VFA is a recognised imaging modality for vertebral fracture identification. The International Society for Clinical Densitometry (ISCD) has published separate criteria in 2007 and 2013 to identify patients suitable for VFA. The aim of this audit is to determine the potential impact on the service of introducing VFA with each set of criteria and to analyse whether this would have any impact on clinical decision making.

Methods: One hundred consecutive patients underwent DEXA-BMD and completed detailed questionnaires regarding osteoporosis risk factors. This information was used to formulate individual management plans, based on the trust’s osteoporosis guidelines. Each patient’s questionnaire was then independently assessed as to whether they met the ISCD 2007 and/or 2013 criteria. From those selected, we used trust guidance to assess whether their immediate clinical management would change if a vertebral fracture was hypothetically identified.

Results: Out of the 100 patients, 69 met the 2007 criteria and 42 the 2013 criteria. The percentage that would have their immediate clinical management changed if a vertebral fracture was identified would be 40.6 and 42.9% for the 2007 and 2013 cohorts respectively.

Conclusions: A study published in 2014 suggests that approximately 25% of eligible patients undergoing VFA would have a vertebral fracture. Using this paper, we were able to estimate that from the 69 patients meeting the 2007 criteria, approximately 16 would have vertebral fractures identified and of these, six patients would have their immediate decisions changed. For the 2013 criteria, 11 out of the 42 patients would have a vertebral fracture identified and five would have their immediate decisions changed. Combining our results with supporting literature led to the recommendation that the 2013 criteria should be introduced at the trust.