The prevalence of undetected vertebral fracture in patients with back pain by dual-energy X-ray absorptiometry (DXA) of the lateral thoracic and Lumbar Spine

Abstract

Study Design: This is a prospective study. Purpose: This study is conducted to determine the prevalence of unrecognized vertebral fracture (VF) in patients who present with back pain. Overview of Literature: VF is often unrecognized, and significantly increases the risk of further fractures. Unfortunately, the patients at a high risk for VF usually do not receive adequate therapy to reduce the fracture risk. Methods: This is a prospective study of 344 patients who presented with back pain from April 2008 to May 2009. The patients underwent dual-energy X-ray absorptiometry (DXA) evaluation and vertebral fracture assessment from T4 to L4 using a hologic densitometer. Results: Three hundred forty four of 386 patients who presented with back pain were included. Forty two patients were excluded because of a prior history of VF or the lack of written consent. Most of the patients were female (95.3%). The mean age of the patients was 58.21 ± 11.74 years. According to the World Health Organization definition (based on the Tscore), 13.4% of the patients had normal lumbar spine bone mineral density (BMD). 27.9% of them were osteopenic and 58.7% were osteoporotic. The overall prevalence of VF, as established by lateral vertebral assessment, was 39% (n = 134). Moreover, 62.6% (n = 84) of the patients with VF had more than one fracture and 64.1% (n = 86) of them had Grade 2 or 3 fracture. Conclusions: We recommend performing not only DXA scanning for BMD evaluation, but also VFA by DXA in old patients with back pain. © 2011 by Korean Society of Spine Surgery.