Osteoporosis on DXA and vertebral fractures on VFA

Case contributed by Neil Powrie
Diagnosis certain


Known osteoporosis. 10 year previous bisphosphonate use. Previous rib and vertebral fractures.

Patient Data

Age: 70 years
Gender: Male

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 vertebral fracture assessment (VFA) image shows:

  • Moderate wedge fractures at T6, T7 and T8.
  • Moderate superior endplate fracture at T11 and T12.
  • Severe 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 patient’s history of osteoporosis. 

The lowest T-score is -3.0 at the lumbar spine, giving a diagnosis of osteoporosis 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. 

Case Discussion

This patient has been on bisphosphonates for 10 years, the referring physician was hoping to give the patient a treatment 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 patient’s risk of further fracture remained high. 

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

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

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