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CC July 2015 Vertebral fracture assessment

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echoecho's version from 2015-10-29 12:56

Section

Question Answer
What testing is the most common method of assessing the presence of bone loss (osteoporosis)?bone mineral density (BMD) testing via dual-energy x-ray absorptiometry (DXA)
What is the T score for a diagnosis of osteoporosis?T score < - 2.5
The presence of what condition is consistent with the diagnosis of osteoporosis even in the absence of a BMD diagnosis?veretebral fracture
The presence of a vertebral fracture changes a patient's future fracture risk estimation (____ x increase in vertebral fracture risk and ___ to ___ x increased risk of nonvertebral fracture) and the threshold for treatment?5; 2-3
What tool can estimate the future fracture risk?FRAX tool (www.shef.ac.uk/FRAX/)
Treatment of a vertebral fracutre is associated with reduction in future fracture risk, true or false?true
Why can't identification of clinical symptoms be used to identify a vertebral fracture?because the majority of vertebral fractures are asymptomatic
List the 2 methods that are available for identification of silent vertebral fractures?1) standard lateral x-rays 2) densitometric vertebral fracture assessment (VFA)
Can VFA be done at the time of BMD? What does it involve in way of radiation exposure?1) yes 2) minimal radiation exposure (3-40 microsieverts)
Compared to VFA, what does standard radiography involve in way of radiation exposure? Comment on the specificity and sensitivity of standard radiographY?1) standard radiography involves significantly more radiation (upwards of 600 microsieverts) 2) it is more sensitive and specific
In a recent study of VFA (vertebral fracture assessment), n=908 asymptomatic, post-menopausal women, fractures were found in ____% of women?42%
Regarding the above study, the identified fracutres were found in ____% of women with normal BMDs and ___% of women with osteopenia?28.3%; 38.5%
In the above study, list the independent risk factors ofr vertebral fracture?1) age > 60 y.o. 2) multiparity 3) low BMI 4) hx of peripheral traumatic fracture
*** VFA (vertebral fracture assessment) is useful in what clinic situation?where the presence of a vertebral fracture would alter the management of the patient
*** What society has published indications for VFA?the Clinical Densitometry (ISCD)
If a pt has had a VFA performed, repeat testing would be indicated if what?there is documented loss in height, new back pain or postural change
Repeat VFA testing (or lateral spine x-ray) is indicated for what patients?those who are considered for discontinuation of osteoporosis medication
The presence of a new vertebral fracutre would warrant what?continued or more aggressive therapy rather than discontinuation
List the ISCD recommendations for VFA for a postmenopausal woman with low bone mass (osteopenia) by BMD criteria, PLUS any of what 5 criteria? ?1) age > 70 y.o. 2) historical height loss ( > 4 cm or 1.6 inch) - amount of height that an individual has lost over her lifetime 3) prospective height loss > 2 cm (0.8 inch) - difference between 2 height measurements taken over the time the patient is being followed 4) self-report vertebral fracture (not previously documented) 5) 2 or more of the following = a) age 60-69 years b) self-reported prior nonvertebral fracture c) historical height loss of 2-4 cm d) chronic systemic diseases associated with increased risk of vertebral fractures (like moderate to severe chronic COPD, seropositive rheumatoid arthritis, Crohn's disease)
What is the ISCD recommendations for VFA in men with low bone mass (osteopenia) by BMD criteria, PLUS any of what 5 criteria?1) age 80 y.o. or older 2) historical height loss > 6 cm (2.4 inches) 3) prospective height loss > 3 cm (1.2 inches) 4) self-reported vertebral fracture (not previously documented) 5) 2 or more of the following = a) age 70-79 years b) self-reported prior nonvertebral fracture c) historical height loss of 3-6 cm d) on pharmacologic androgen deprivation therapy or following orchiectomy e) chronic systemic diseases associated with increased risk of vertebral fractures ( like moderate to severe COPD, seropositive rheumatoid arthritis, Crohn's disease)
*** SUMMARY - What is a useful tool in clinical situations where the presence of a vertebral fracture would alter the management of the patient? VFA (vertebral fracture assessment)
Compared to lateral spine x-rays, does VFA involve more or less radiation? Is VFA more or less sensitive and specific than lateral spine x-rays?1) VFA involves less radiation than lateral spine x-rays 2) VFA is less sensitive and specific than lateral spine x-rays
*** SUMMARY = Can VFA be done at the time of bone mineral density testing?yes
*** SUMMARY = the majority of fractures are _____ (asymptomatic vs. symptomatic), but vertebral fractures is associated with an increased _____ ____ risk?asymptomatic; future fracture
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