Introduction: Vertebral fracture is one of the major osteoporotic
fractures which are unfortunately very often undetected. In addition, it
is well known that prevalent vertebral fracture increases dramatically
the risk of future additional fracture. Instant Vertebral Assessment (IVA)
has been introduced in DXA device couple years ago to ease the
detection of such fracture when routine DXA are performed. To
correctly use such tool, ISCD provided clinical recommendation on
when and how to use it. The aim of our study was to evaluate the ISCD
guidelines in clinical routine patients and see how often it may change
of patient management.
Methods: During two months (March and April 2010), a medical
questionnaire was systematically given to our clinical routine patient to
check the validity of ISCD IVA recommendations in our population. In
addition, all women had BMD measurement at AP spine, Femur and
1/3 radius using a Discovery A System (Hologic, Waltham, USA). When
appropriate, IVA measurement had been performed on the same DXA
system and had been centrally evaluated by two trained Doctors for
fracture status according to the semi-quantitative method of Genant.
The reading had been performed when possible between L5 and T4.
Results: Out of 210 women seen in the consultation, 109 (52%)
of them (mean age 68.2 ± 11.5 years) fulfilled the necessary criteria to
have an IVA measurement. Out of these 109 women, 43 (incidence
39.4%) had osteoporosis at one of the three skeletal sites and 31
(incidence 28.4%) had at least one vertebral fracture. 14.7% of women
had both osteoporosis and at least one vertebral fracture classifying
them as "severe osteoporosis" while 46.8% did not have osteoporosis
nor vertebral fracture. 24.8% of the women had osteoporosis but no
vertebral fracture while 13.8% of women did have osteoporosis and
vertebral fracture (clinical osteoporosis).
Conclusion: In conclusion, in 52% of our patients, IVA was needed
according to ISCD criteria. In half of them the IVA test influenced of
patient management either by changing the type of treatment of simply
by classifying patient as "clinical osteoporosis". IVA appears to be an
important tool in clinical routine but unfortunately is not yet very often
used in most of the centers.