Identification of prevalent vertebral fractures using vertebral fracture assessment (VFA) in asymptomatic postmenopausal women:​ a systematic review and meta-analysis

Yang, Jingyan<sup>1,2</sup>; Mao, Yushan<sup>3</sup>; Nieves, Jeri W.<sup>4,5</sup>

Affiliations

¹Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, USA

²Patient Health and Impact, Pfizer Inc., New York, NY, USA

³Department of Endocrinology, The Affiliated Hospital of Medical School, Ningbo University, Zhejiang, China

⁴Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

⁵Hospital for Special Surgery, New York, NY, USA

Abstract and keywords

Background: Vertebral fracture (VF) is the most common osteoporotic fracture in postmenopausal women, although most VFs are subclinical. Prevalent VFs are a significant predictor of subsequent fracture and therefore, identification of VF improves the identification of those with high fracture risk. The aim of present study was to systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry.

Method: Medline, Web of Science and Cochrane databases were searched between Jan 1st, 2000 and Jan 31st, 2018, for publications in English that reported the prevalence of VFA-detected VF in asymptomatic postmenopausal women. We also searched for reports, conference papers and grey literature. Reviewers screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were performed to calculate the prevalence of VF. The presence of publication bias was assessed using funnel plots by precision and Egger's Test of the Intercept.

Results: A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n = 25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2 years old. The prevalence of osteoporosis and osteopenia varied between 6–57.0% and 25.1–58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%–32%).

Conclusion: VFA is able to identify prevalent VF in asymptomatic postmenopausal women. The use of VFA identified an average of 28% of asymptomatic women with VFs, many of whom did not have a diagnosis of osteoporosis. Implementation of VFA as a routine screening tool may detect high risk women. Detection of VF might lead to pharmacological treatment in individuals who may not otherwise be treated.

Keywords: Vertebral Fracture Assessment; Vertebral fracture; Prevalence; Postmenopausal women; Osteoporosis

Links

DOI: 10.1016/j.bone.2020.115358

PubMed: 32268210

WoS: 000535131500017

History

Received: 2019-11-7

Revised: 2020-04-3

Accepted: 2020-04-3

Online: 2020-04-5

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Cited By (1)

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2022	Cosman F, Huang S, McDermott M, Cummings SR. Multiple vertebral fractures after denosumab discontinuation: FREEDOM and FREEDOM extension trials additional post hoc analyses. J Bone Miner Res. November 2022;37(11):2112-2120.