[Efficient and improved diagnosis of osteoporosis by simultaneous bone density measurement and spinal morphometry]

As the vertebral fracture status is an important and independent parameter for the prediction of future fractures, we aimed to determine the added value of spinal morphometry performed in combination with bone density measurement in the determination of vertebral fracture status in patients referred for conventional bone density measurement.

Prospective, observational.

Consecutive patients referred to our university medical centre department for bone mineral density measurement also underwent spinal morphometry at the same session. The primary outcome parameter was the prevalence of vertebral fractures.

A total of 958 patients were included. In 28% the indication was primary osteoporosis, and in 72% it was secondary osteoporosis. In 98% spinal morphometry was technically successful. In 681 patients (71%) Lvi-Tiv and in 826 (86%) Liv-Tv were visualized. One or more fractures were found in 25% of patients; a mean of 1.8 vertebral fractures per patient. In 68% of these patients this fracture was previously unknown. Most fractures (76%) were wedge shaped. The degree of severity of the fracture was mild in 43%, moderate in 44%, and severe in 13%. Even after excluding mild fractures, the prevalence of vertebral fractures was 17%. Bone density classification was normal in 28% of patients. There was osteopenia in 43% and osteoporosis in 29%. The prevalence of vertebral fractures in these subgroups was 18%, 23% and 36% respectively.

Including spinal morphometry in bone mineral density measurement is of added value as this method detected previously unknown vertebral fractures in a great number of patients.