Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations.

UNLABELLED: Vertebral Fracture Analysis enables the detection of vertebral fractures in the same session as bone mineral density testing. Using this method in 2,424 patients, we found unknown vertebral fractures in approximately one out of each six patients with significant impact on management. INTRODUCTION: The presence of osteoporotic vertebral fractures (VF) is an important risk factor for all future fractures independent of BMD. Yet, determination of the VF status has not become standard practice. Vertebral Fracture Assessment (VFA) is a new feature available on modern densitometers. In this study we aimed to determine the prevalence of VF using VFA in all patients referred for BMD testing in a university medical center and to evaluate its added clinical value. METHODS: Prospective diagnostic evaluation study in 2,500 consecutive patients referred for BMD. Patients underwent VFA in supine position after BMD testing. Questionnaires were used to assess perceived added value of VFA. RESULTS: In 2,424 patients (1,573 women), results were evaluable. In 541 patients (22%), VFA detected a prevalent VF that was unknown in 69%. In women, the prevalence was 20% versus 27% found in men (p < 0.0001). The prevalence of VF was 14% in patients with normal BMD (97/678), increased to 21% (229/1,100) in osteopenia and to 26% in those with osteoporosis (215/646) by WHO criteria. After excluding mild fractures VF prevalence was 13% (322/2,424). In 468 of 942 questionnaires (50% response rate), 27% of the referring physicians reported VFA results to impact on patient management. CONCLUSIONS: VFA is a patient friendly new tool with a high diagnostic yield, as it detected unknown VF in one out of each six patients, with significant impact on management. We believe these findings justify considering VFA in all new patients referred for osteoporosis assessment in similar populations.

[Efficient and improved diagnosis of osteoporosis by simultaneous bone density measurement and spinal morphometry]. / Efficiënte en verbeterde diagnostiek van osteoporose door simultane botdichtheidsmeting en wervelmorfometrie.

OBJECTIVE: 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. DESIGN: Prospective, observational. METHOD: 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. RESULTS: 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. CONCLUSION: 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.

Can a smart chair improve the sitting behavior of office workers?

Prolonged sitting can cause health problems and musculoskeletal discomfort. There is a need for objective and non-obstructive means of measuring sitting behavior. A 'smart' office chair can monitor sitting behavior and provide tactile feedback, aiming to improve sitting behavior. This study aimed to investigate the effect of the feedback signal on sitting behavior and musculoskeletal discomfort. In a 12-week prospective cohort study (ABCB design) among office workers (n = 45) was measured sitting duration and posture, feedback signals and musculoskeletal discomfort. Between the study phases, small changes were observed in mean sitting duration, posture and discomfort. After turning off the feedback signal, a slight increase in sitting duration was observed (10 min, p = 0.04), a slight decrease in optimally supported posture (2.8%, p < 0.01), and musculoskeletal discomfort (0.8, p < 0.01) was observed. We conclude that the 'smart' chair is able to monitor the sitting behavior, the feedback signal, however, led to small or insignificant changes.