The researchers for the New England Journal of Medicine article about DXA counted only those few vertebral (spine) fractures that were recognized as fractures. Most vertebral fractures, especially in older women and in men, are mistaken for muscle pulls or arthritis.
Usually bones in the spine gradually crumble rather than suddenly crunch. These “silent” fractures count the same as (recognized) “clinical” fractures when calculating Future Fracture Risk and planning care. The researchers ignored this very important detail.
A single vertebral fracture of 25% increases the risk of future vertebral fractures 5 times and the risk of a future hip fracture 2 times. “Silent” vertebral fractures (seen only on x-ray) carry exactly the same risk as (recognized) “clinical” fractures. “Silent” fractures are 4 to 5 times more common than “clinical” fractures. Multiple fractures multiply risk of future fractures even more.
The only way to find a “silent” vertebral fracture is by VFA, either by a DXA machine with that capability (like ours), or by lateral x-ray of the spine. Even smart patients can be fooled.
30 years ago I “really pulled a muscle in my back” doing something foolish. Only when I was a test patient for our new DXA machine did I discover that I had actually crunched a vertebra by 30%. If a trained professional like myself can be fooled, so can you.
Individuals with “silent” vertebral fractures deserve further evaluation of their Fracture Risk and often need treatment to reduce that risk. This study by DXA alone, even with “clinical” fractures counted, probably missed more than half of the individuals requiring treatment and repeat testing.
Don’t be missed by getting only a DXA! Get the full evaluation.
Jay Ginther, MD