Among older patients at risk for osteoporosis, hidden vertebral fractures substantially increase the risk of both hip fractures and additional vertebral fractures. But physicians from the Danville, Pa.-based Geisinger Health System have evaluated a vertebral fracture assessment (VFA) technique that allows fracture evaluation at the same time as a standard DXA bone density test – at a cost of just an additional $17 per test.

The cost to find a hidden vertebral fracture through this new technique is also approximately one-third of what it would have cost through existing DXA testing procedures.

Eric Newman, MD, director of the rheumatology department, and vice-chairman of the medical division at Geisinger joined with colleagues Thomas Olenginski, MD, James Perruquet, MD, Jennifer Hummel and Mary Hummer in scientifically evaluating the VFA technique. They reported its success in a Plenary Session Podium Presentation titled “Vertebral Fracture Analysis using DXA – A Clinically Important and Inexpensive Method to Improve Osteoporosis Risk Stratification,” at the National American College of Rheumatology meeting in San Diego last November. Only 12 of the more than 3,000 presentations at the meeting were chosen for Plenary Session Presentations, which were delivered before more than 4,000 medical officials from around the world.

“DXA is a simple, safe, comfortable X-ray study that is the gold standard test for diagnosing osteoporosis and assessing future fracture risk. VFA is a new capability with certain DXA machines, that allows us to additionally assess whether someone has an existing vertebral fracture,” says Newman.

“This [VFA] is important because three out of four spine fractures are asymptomatic – people don’t know that they have them, up to 30 percent of women over 50 may have a vertebral fracture, and the presence of a vertebral fracture that is not from trauma is a very strong predictor of future fracture at the spine, wrist and hip, and by itself is enough to warrant treatment. Our study has researched, analyzed and redesigned care to find the best pathway for using VFA – rolling it out on a large scale, and examining the costs vs. benefits.”

Between October 2003 and February 2005, Geisinger researchers performed 2,155 VFAs during 3,745 DXA bone density exams. Vertebral fractures were found in 463 patients (21.5 percent) – with multiple vertebral fractures found in 172 patients (8 percent). Diagnosis of “risk changed to high” occurred in 153 patients (7 percent) – meaning that one out of 14 IVAs performed resulted in a significant change in risk diagnosis, and corresponding therapeutic recommendations.

By incorporating IVA as part of their regular DXA bone density testing protocol, the additional cost per test was only $17. According to the research, the cost to discover one vertebral fracture by IVA was $140. By comparison, the cost to discover a high-risk patient across all 7,368 patients who have received DXA bone density tests was $405.

“[VFA] is a technique that allows quantitative vertebral fracture evaluation and can be performed at the same time as a standard DXA. VFA has significant advantages over plain radiography of the spine, including lower radiation exposure, lower cost, patient convenience and ability to integrate results with DXA. This allows us to give the ordering physician a single, integrated and consultative report,” says Newman.

“Utilizing an age-based protocol, vertebral fracture analysis utilizing VFA can be easily incorporated into a DXA program. Unsuspected vertebral fractures are commonly seen. This study demonstrates that combining VFA with DXA provides essential diagnostic and therapeutic information at a nominal additional cost.”

Source: Dick Jones Communications