Osteoporosis on DXA and vertebral fractures on VFA

This patient has been on bisphosphonates for 10 years, the referring physician was hoping to give the patient a break from therapytreatment holiday. 

There was a small improvement in BMD and none of the vertebral fractures demonstrated were new. 

However given the low BMD and history of multiple fractures, the patientspatient’s risk of further fracture remained high. 

A Z-score of -2.0 suggests a possible secondary cause of osteoporosis. Examination of the patientspatient’s risk factors at the time of the scan revealed a history of Crohn's disease and previous corticosteroid use. 

The report recommended specialist opinion with regards to a break from therapy. 

The lumbar spine images show vertebral fractures at T12 and L1. L1 has therefore been excluded from the analysis. 

The hip measurement is of good technical quality. 

The VFA image shows:

• Moderate wedge fractures at T6, T7 and T8.
• Moderate superior endplate fracture at T11 and T12.
• A severeSevere wedge fracture at L1.

There is some mild loss of height at T10 (relative to T9), however there is no definite central endplate depression and this cannot be confirmed to be a fracture on this image. 

These findings are consistent with the patientspatient’s history of osteoporosis. 

The lowest T-score is -3.0 at the lumbar spine, giving a diagnosis of Osteoporosisosteoporosis according to WHO criteria (<-2.5). 

The Z-score at the lumbar spine is -2.5, the patients BMD is below the expected range for their age. 

Since the previous scan there has been a 6.7% increase in BMD at the spine, which surpasses the least significant change. 

There is no statistically significant change in BMD at the hip. 

Given the patientspatient’s medical history, what is the relevance of the VFA results?

This patient has a history of 10 years’ oral bisphosphonate therapy. What are the potential complications of long term bisphosphonate use?