Morphometric dual-energy X-ray absorptiometry (MXA) for identification of vertebral fractures

Visual identification of vertebral fractures from spinal radiographs makes use of operator expertise in ruling out non-fracture deformities or normal variants. Morphometric X-ray absorptiometry (MXA) has recently been developed to assess vertebral deformity status quantitatively by dual energy X-ray absorptiometry (DXA). The reliability of MXA measurements depends on the precision of the technique, and this is influenced by system error, variability associated with morphometric analysis, and variability within study populations. This technique has proved to be useful in the identification and evaluation of osteoporotic vertebral deformities in both epidemiologic surveys and clinical trials. The major limitation of DXA vertebral assessment is the poor quality of images of thoracic vertebrae. We conclude that, used as a screening tool, this approach may help to identify vertebral fractures with a reduced radiation dose to the patient, and that technological improvements are necessary to improve image quality.