Top

Osteoporosis International

Published in:

01-11-2015 | Original Article

Diagnosis of vertebral fractures using a low-dose biplanar imaging system

Authors: K. Briot, J. Fechtenbaum, A. Etcheto, S. Kolta, A. Feydy, C. Roux

Published in: Osteoporosis International | Issue 11/2015

Abstract

Summary

Vertebral fractures (VFs) are independent risk factors for new fractures. However, spine radiographs cannot be used as a screening method. EOS® has a good diagnostic value for the diagnosis of VF with a better legibility of upper thoracic spine and a higher concordance between readers compared to vertebral fracture assessment (VFA).

Introduction

Vertebral fractures (VFs) are risk factors for new fractures. However, spine radiographs cannot be used as a screening method for both cost and radiation concerns. EOS® X-ray imaging system which allows the acquisition of biplane images in an upright weight-bearing position with low radiation dose was used. The objective of this study was to compare EOS® to VFA for the diagnosis of VF.

Methods

We conducted a cross-sectional study in subjects aged above 50 years with indication for spine imaging. EOS® and VFA of the spine were performed the same day. Sensitivity (Se), specificity (Sp), negative predictive value (NPV), and the interobserver precision of EOS® were compared to VFA for the diagnosis of VF.

Results

Two hundred patients (mean age 66.2 years) were included. At the vertebral level, 2.4 and 3.6 % of vertebrae were not legible using EOS® and VFA, respectively (p = 0.0007). The legibility of spine was significantly affected by scoliosis (odds ratio (OR) = 2.8, p < 0.0001, for EOS®, and OR = 1.8, p = 0.0041, for VFA). Sixty-six patients (33.0 %) and 69 (34.5 %) had at least one VF using VFA and EOS®, respectively. At patient level, Se, Sp, and NPV for the diagnosis of VF of EOS® were 79.7, 91.6, and 99 %, respectively. Concordance between both observers was very good for EOS® (kappa-score = 0.89), higher than for VFA (κ = 0.67).

Conclusions

This study shows that EOS® has a good diagnostic value for the diagnosis of VF with a better legibility of upper thoracic spine and a higher concordance between readers compared to VFA.

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–21CrossRefPubMed

Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–8CrossRefPubMed

Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–3CrossRefPubMed

Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–23CrossRefPubMed

Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–24CrossRefPubMed

Kerkeni S, Kolta S, Fechtenbaum J, Roux C (2009) Spinal deformity index (SDI) is a good predictor of incident vertebral fractures. Osteoporos Int 20:1547–52CrossRefPubMed

Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. Bone 25:613–9CrossRefPubMed

Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH (2007) Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int 18:761–70CrossRefPubMed

Netelenbos JC, Lems WF, Geusens PP, Verhaar HJ, Boermans AJ, Boomsma MM, Mulder PG, Papapoulos SE (2009) Spine radiographs to improve the identification of women at high risk for fractures. Osteoporos Int 20:1347–52CrossRefPubMed

10.

Gallacher SJ, Gallagher AP, McQuillian C, Mitchell PJ, Dixon T (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos Int 18:185–92PubMedCentralCrossRefPubMed

11.

Roux C, Priol G, Fechtenbaum J, Cortet B, Liu-Léage S, Audran M (2007) A clinical tool to determine the necessity of spine radiography in postmenopausal women with osteoporosis presenting with back pain. Ann Rheum Dis 66:81–5PubMedCentralCrossRefPubMed

12.

Kaptoge S, Armbrecht G, Felsenberg D, Lunt M, O’Neill TW, Silman AJ, Reeve J, EPOS Study Group (2004) When should the doctor order a spine X-ray? Identifying vertebral fractures for osteoporosis care: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 19:1982–93CrossRefPubMed

13.

Schousboe JT, Ensrud KE, Nyman JA, Kane RL, Melton LJ 3rd (2005) Potential cost-effective use of spine radiographs to detect vertebral deformity and select osteopenic post-menopausal women for amino-bisphosphonate therapy. Osteoporos Int 16:1883–93CrossRefPubMed

14.

Lewis MK, Blake GM, Fogelman I (1994) Patient dose in dual x-ray absorptiometry. Osteoporos Int 4:11–5CrossRefPubMed

15.

Ferrar L, Jiang G, Barrington NA, Eastell R (2000) Identification of vertebral deformities in women: comparison of radiological assessment and quantitative morphometry using morphometric radiography and morphometric X-ray absorptiometry. J Bone Miner Res 15:575–585CrossRefPubMed

16.

Ferrar L, Jiang G, Eastell R, Peel NFA (2003) Visual evaluation of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res 18:933–938CrossRefPubMed

17.

Damiano J, Kolta S, Porcher R, Tournoux C, Dougados M, Roux C (2006) Diagnosis of vertebral fractures by vertebral fracture assessment. J Clin Densitom 9:66–71CrossRefPubMed

18.

Chapurlat RD, Duboeuf F, Marion-Audibert HO, Kalpakçioglu B, Mitlak BH, Delmas P (2006) Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 1:1189–95CrossRef

19.

Buehring B, Krueger D, Checovich M, Gemar D, Vallarta-Ast N, Genant HK, Binkley N (2010) Vertebral fracture assessment: impact of instrument and reader. Osteoporos Int 21:487–94CrossRefPubMed

20.

Hospers IC, van der Laan JG, Zeebregts CJ, Nieboer P, Wolffenbuttel BH, Dierckx RA, Kreeftenberg HG, Jager PL, Slart RH (2009) Vertebral fracture assessment in supine position: comparison by using conventional semiquantitative radiography and visual radiography. Radiology 251:822–8CrossRefPubMed

21.

Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive Summary of the 2013 ISCD Position Development Conference on Bone Densitometry. J Clin Densitom 16:455–467CrossRefPubMed

22.

Roux C, Fechtenbaum J, Kolta S, Said-Nahal R, Briot K, Benhamou CL (2010) Prospective assessment of thoracic kyphosis in postmenopausal women with osteoporosis. J Bone Miner Res 25:362–8CrossRefPubMed

23.

Kado DM, Miller-Martinez D, Lui LY, Cawthon P, Katzman WB, Hillier TA, Fink HA, Ensrud KE (2014) Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res 29:2210–6PubMedCentralCrossRefPubMed

24.

Wade R, Yang H, McKenna C, Faria R, Gummerson N, Woolacott N (2013) A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system. Eur Spine J 22:296–304PubMedCentralCrossRefPubMed

25.

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–48CrossRefPubMed

26.

Roux C, Baron G, Audran M, Breuil V, Chapurlat R, Cortet B, Fardellone P, Trémollières F, Ravaud P (2011) Influence of vertebral fracture assessment by dual-energy X-ray absorptiometry on decision-making in osteoporosis: a structured vignette survey. Rheumatology (Oxford) 50:2264–9CrossRef

27.

Deschênes S, Charron G, Beaudoin G, Labelle H, Dubois J, Miron MC, Parent S (2010) Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager. Spine (Phila Pa 1976) 35:989–94CrossRef

28.

Moltó A, Freire V, Feydy A, Paternotte S, Maksymowych WP, Benhamou M, Rannou F, Dougados M, Gossec L (2014) Assessing structural changes in axial spondyloarthritis using a low-dose biplanar imaging system. Rheumatology (Oxford) 53:1669–75CrossRef

29.

Ronckers CM, Land CE, Miller JS, Stovall M, Lonstein JE, Doody MM (2010) Cancer mortality among women frequently exposed to radiographic examinations for spinal disorders. Radiat Res 174:83–90PubMedCentralCrossRefPubMed

30.

Dietrich TJ, Pfirrmann SA, Pankalla K, Buck FM (2013) Comparison of radiation dose, workflow, patient comfort and financial break-even of standard digital radiography and a novel biplanar low-dose X-ray system for upright full-length lower limb and whole spine radiography. Skeletal Radiol 42:959–67CrossRefPubMed

31.

Fink HA, Milavetz DL, Palermo L, Nevitt MC, Cauley JA, Genant HK, Black DM, Ensrud KE, Fracture Intervention Trial Research Group (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 20:1216–22CrossRefPubMed

Title: Diagnosis of vertebral fractures using a low-dose biplanar imaging system
Authors: K. Briot
J. Fechtenbaum
A. Etcheto
S. Kolta
A. Feydy
C. Roux
Publication date: 01-11-2015
Publisher: Springer London
Published in: Osteoporosis International / Issue 11/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3190-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnosis of vertebral fractures using a low-dose biplanar imaging system

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 11/2015

Erratum to: Odanacatib for the treatment of postmenopausal osteoporosis: development history and design and participant characteristics of LOFT, the Long-Term Odanacatib Fracture Trial

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

A survey of outcomes and management of patients post fragility fractures in China

Erratum to: Alendronate sodium/vitamin D3 combination tablet versus calcitriol for osteoporosis in Chinese postmenopausal women: a 6-month, randomized, open-label, active-comparator-controlled study with a 6-month extension

Circulating monocytes: an appropriate model for bone-related study

Bone histomorphometry in diabetes mellitus