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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/25488

Title: Effect of implementation of guidelines on assessment and diagnosis of vertebral fractures in patients older than 50 years with a recent non-vertebral fracture
Authors: van der Velde, R. Y.
Bours, S. P. G.
Wyers, C. E.
Lems, W. F.
Geusens, Piet
van den Bergh, Joop P. W.
Issue Date: 2017
Citation: OSTEOPOROSIS INTERNATIONAL, 28(10), p. 3017-3022
Abstract: The Summary We evaluated the impact of a new Dutch guideline on systematic implementation of densitometric Vertebral Fracture Assessment (VFA) in patients with a recent nonvertebral fracture. Systematic implementation resulted in a significant increase of VFA, diagnosis of vertebral fractures (VFs), and percentage of patients eligible for treatment. Introduction VFs are underdiagnosed although they are important predictors of fracture risk, independent of age and bone mineral density (BMD). The Dutch guideline on osteoporosis and fracture prevention recommends VFA in all patients aged > 50 years with a recent non-VF. Our aim was to evaluate the effect of systematic implementation of densitometric VFA in patients with a recent non-VF at the fracture liaison service (FLS). Methods VFA was performed on lateral images of the spine using dual-energy X-ray absorptiometry (DXA) and graded according to Genant using Spine Analyzer software. Results We evaluated 582 patients before and 484 after implementation (mean age 67 and 66 years; 71 and 74% women, respectively). Performing VFA increased from 4.6 to 97.1% (p < 0.001) and the diagnosis of VFs from 2.2 to 26.2% for grade >= 1 (p < 0.001) and from 0.9 to 14.7% for grade >= 2 (p < 0.001). Prevalence of VFs increased with age (5.2% in 50-59-year olds to 27.8% in 80+-year olds, p < 0.001), but was similar for both genders, non-VF locations, and BMD. Including patients with osteopenia and a VF increased the percentage of patients eligible for treatment by a quarter, from 31.0% in the pre-guideline to 38.4% in the post-guideline cohort. Conclusions Systematic guideline implementation resulted in a significant increase of VFA, diagnosis of VFs, and percentage of patients eligible for treatment. VFA contributes to documenting the high prevalence of VFs in patients visiting the FLS with a non-VF in both genders, at any age, non-VF location, and BMD.
Notes: [van der Velde, R. Y.; Wyers, C. E.; van den Bergh, J. P. W.] VieCuri Med Ctr North Limburg, Dept Internal Med, Tegelseweg 210, NL-5912 BL Venlo, Netherlands. [van der Velde, R. Y.; Wyers, C. E.; van den Bergh, J. P. W.] Maastricht UMC, NUTRIM Sch Nutr & Translat Res Metab, Dept Internal Med, Maastricht, Netherlands. [Bours, S. P. G.; Geusens, P. P. M. M.] Maastricht UMC, CAPHRI, Dept Rheumatol, Maastricht, Netherlands. [Lems, W. F.] Vrije Univ Amsterdam Med Ctr, Dept Rheumatol, Amsterdam, Netherlands. [Geusens, P. P. M. M.; van den Bergh, J. P. W.] Univ Hasselt, Biomed Res Ctr, Hasselt, Belgium.
URI: http://hdl.handle.net/1942/25488
DOI: 10.1007/s00198-017-4147-4
ISI #: 000412164400029
ISSN: 0937-941X
Category: A1
Type: Journal Contribution
Validation: ecoom, 2018
Appears in Collections: Research publications

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