Journal of Clinical Densitometry
Volume 10, Issue 3 , Pages 227-238 , July 2007

Vertebral Fracture Assessment by Dual-Energy X-ray Absorptiometry: Insurance Coverage Issues in the United States A White Paper of the International Society for Clinical Densitometry

  • Andrew J. Laster

      Affiliations

    • Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, NC
    • Corresponding Author InformationAddress correspondence to: Andrew J Laster MD, FACR, CCD, Arthritis & Osteoporosis Consultants of the Carolinas, 1918 Randolph Rd., Suite 600, Charlotte, NC 28207.
  • ,
  • E. Michael Lewiecki

      Affiliations

    • New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM
  • ,
  • for the ISCD Board of Directors

Received 15 January 2007 ,Revised 24 April 2007 ,Accepted 26 April 2007.

References 

  1. Lewis MK, Blake GM, Fogelman I. Patient dose in dual x-ray absorptiometry. Osteoporos Int. 1994;4:11–15
  2. Genant HK, Engelke K, Fuerst T, et al. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner. 1996;11:707–730
  3. Description of BCBS TEC. Blue Cross Blue Shield Association [serial online]. Available at: www.bcbs.com/tec/whatistec.htmlAccessed August 27, 2006
  4. BCBSA TEC . Vertebral assessment using dual-energy x-ray absorptiometry for osteoporotic fracture risk assessment. BCBSA TEC Assessment Program [serial online]. Available at: http://www.bcbs.com/tec/vol19/19_14.html2004;Accessed: June 14, 2007
  5. BCBSA TEC . Screening for vertebral fracture with dual x-ray absorptiometry. BCBSA TEC Assessment Program [serial online]. Available at: http://www.bcbs.com/tec/vol20/20_14.html2006;Accessed: June 14, 2007
  6. Denial of coverage for VFA by Aetna. Aetna Healthcare web site [serial online]. Available at: http://www.aetna.com/cpb/data/CPBA0134.htmlAccessed August 24, 2006
  7. Trailblazer denial of coverage for VFA. Trailblazer web site [serial online]. Available at: http://www.trailblazerhealth.com/draftindex.asp?ID=265Accessed August 23, 6 A.D.
  8. Palmetto GBA coverage of VFA. Palmetto GBA web site [serial online]. Available at: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=5787&;lcd_version=22&basket=lcd%3A5787%3A22%3ABONE±MASS±MEASUREMENT%3ACarrier%3APalmetto±GBA±%2800880%29%3AAccessed August 24, 2006
  9. FCSO coverage policy of VFA. First Coast Service Option web site [serial online] Available at: www.floridamedicare.comAccessed August 23, 2006
  10. Vokes T, Bachman D, Baim S, et al. Vertebral fracture assessment: the 2005 ISCD Official Positions. J Clin Densitom. 2006;9:37–46
  11. Riggs BL, Melton LJ. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995;17(Suppl):S505–S511
  12. Melton LJ, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. 1989;120:1000–1011
  13. Kanis JA, Johnell O, Oden A, et al. The risk and burden of vertebral fractures in Sweden. Osteoporos Int. 2004;15(1):20–26
  14. Ettinger B, Black DM, Nevitt MC, et al. Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1992;7:449–456
  15. Silverman SL. The clinical consequences of vertebral compression fracture. Bone. 1992;13(Suppl 2):S27–S31
  16. Nevitt MC, Ettinger B, Black DM, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med. 1998;128:793–800
  17. Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL. Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med. 1993;94:595–601
  18. Ensrud KE, Thompson DE, Cauley JA, et al. Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc. 2000;48:241–249
  19. Johnell O, Kanis JA, Oden A, et al. Mortality after osteoporotic fractures. Osteoporos Int. 2004;15(1):38–42
  20. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999;159:1215–1220
  21. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1999;14:821–828
  22. Melton LJ, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL. Vertebral fractures predict subsequent fractures. Osteoporos Int. 1999;10:214–221
  23. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991;114:919–923
  24. Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD. Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int. 1993;3:120–126
  25. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285:320–323
  26. Lunt M, O'Neill TW, Felsenberg D, et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone. 2003;33:505–513
  27. Gallagher JC, Genant HK, Crans GG, Vargas SJ, Krege JH. Teriparatide reduces the fracture risk associated with increasing number and severity of osteoporotic fractures. J Clin Endocrinol Metab. 2005;90:1583–1587
  28. Delmas PD, Genant HK, Crans GG, et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 2003;33:522–532
  29. Pongchaiyakul C, Nguyen ND, Jones G, Center JR, Eisman JA, Nguyen TV. Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res. 2005;20:1349–1355
  30. World Health Organization . Assessment of fracture risk and its application to screening for post menopausal osteoporosis. Geneva, Switzerland: World Health Organization; 1994;
  31. NIH Consensus Development Panel on Osteoporosis. JAMA. 2001;285:785–795
  32. Pasco JA, Seeman E, Henry MJ, Merriman EN, Nicholson GC, Kotowicz MA. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int. 2006;1–6
  33. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348:1535–1541
  34. Chesnut CH, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med. 2000;109:267–276
  35. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999;282:637–645
  36. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344–1352
  37. Reginster J, Minne HW, Sorensen OH, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000;11:83–91
  38. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434–1441
  39. Kanis JA, Barton IP, Johnell O. Risedronate decreases fracture risk in patients selected solely on the basis of prior vertebral fracture. Osteoporos Int. 2005;16:475–482
  40. Quandt SA, Thompson DE, Schneider DL, Nevitt MC, Black DM. Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of −1.6 to −2.5 at the femoral neck: the Fracture Intervention Trial. Mayo Clin Proc. 2005;80:343–349
  41. Stock JL. Lilly/Data on file. 2005;
  42. Fletcher H. Anterior vertebral wedging: frequency and significance. AJR. 1947;57:232–238
  43. Barnett E, Nordin BE. The radiological diagnosis of osteoporosis: a new approach. Clin Radiol. 1960;11:166–174
  44. Hurxthal LM. Measurement of anterior wedging vertebral compressions and biconcave vertebrae. AJR. 1968;103:635–644
  45. Smith RW, Eyeler WR, Mellinger RC. On the incidence of senile osteoporosis. Ann Intern Med. 1960;52:773–781
  46. Minne HW, Leidig G, Wuster C, et al. A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner. 1988;3:335–349
  47. Black DM, Cummings SR, Stone K, Hudes E, Palermo L, Steiger P. A new approach to defining normal vertebral dimensions. J Bone Miner Res. 1991;6:883–892
  48. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ. Classification of vertebral fractures. J Bone Miner Res. 1991;6:207–215
  49. McCloskey EV, Spector TD, Eyres KS, et al. The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int. 1993;3:138–147
  50. Genant HK, Wu CY, van KC, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8:1137–1148
  51. Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR. Recognition of vertebral fracture in a clinical setting. Osteoporos Int. 2000;11:577–582
  52. Majumdar SR, Kim N, Colman I, et al. Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. Arch Intern Med. 2005;165:905–909
  53. Delmas PD, van de LL, Watts NB, et al. Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res. 2005;20:557–563
  54. Lenchik L, Rogers LF, Delmas PD, Genant HK. Diagnosis of osteoporotic vertebral fractures: importance of recognition and description by radiologists. AJR Am J Roentgenol. 2004;183:949–958
  55. Li J, Wu CY, Jergas M. Vertebral fracture in osteoporosis. In:  Genant HK,  Jergas M,  van Kuijk C editor. San Francisco, CA: University of California; 1995;p. 271–279
  56. Wu CY, Li J, Jergas M, Genant HK. Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures. Osteoporos Int. 1995;5:354–370
  57. Fechtenbaum J, Cropet C, Kolta S, Verdoncq B, Orcel P, Roux C. Reporting of vertebral fractures on spine X-rays. Osteoporos Int. 2005;16:1823–1826
  58. Genant H. International Osteoporosis Foundation, European Society of Musculoskeletal Radiology Osteoporosis: recognising and reporting vertebral fractures. International Osteoporosis Foundation. [serial online]. Available at: http://www.osteofound.org/health_professionals/vfi/assets/resources/Summary-Handout-en.pdfAccessed August 29, 2006
  59. Ferrar L, Jiang G, Eastell R, Peel NF. Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res. 2003;18:933–938
  60. Schousboe JT, Debold CR. Reliability and accuracy of vertebral fracture assessment with densitometry compared to radiography in clinical practice. Osteoporos Int. 2006;17:281–289
  61. Rea JA, Chen MB, Li J, et al. Morphometric X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res. 2000;15:564–574
  62. Rea JA, Li J, Blake GM, Steiger P, Genant HK, Fogelman I. Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int. 2000;11:660–668
  63. Binkley N, Krueger D, Gangnon R, Genant HK, Drezner MK. Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures. Osteoporos Int. 2005;16:1513–1518
  64. Schousboe JT, Debold CR, Bowles C, Glickstein S, Rubino RK. Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry. J Clin Densitom. 2002;5:239–246
  65. Clark KC. Positioning in radiography. Oxford, UK: Butterworth-Heinemanns; 1986;
  66. van der Klift M, de Laet CE, McCloskey EV, Hofman A, Pols HA. The incidence of vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res. 2002;17:1051–1056
  67. Wu C, Genant HK, von Ingersleben G, et al. Validation of lateral DXA imaging for assessment of vertebral fractures. J Bone Miner Res. 2004;19(Suppl 1):S295
  68. Vokes TJ, Dixon LB, Favus MJ. Clinical utility of dual-energy vertebral assessment (DVA). Osteoporos Int. 2003;14:871–878
  69. Genant HK, Mitlak BH, Myers S, Wang O. Radiographic fracture grade is related to clinical disease severity. Results from the rhPTH (1-34) fracture prevention study. Arthritis Rheum. 2000;43:S383
  70. Jacobs-Kosmin D, Sandorfi N, Murray H, Abruzzo JL. Vertebral deformities identified by vertebral fracture assessment: associations with clinical characteristics and bone mineral density. J Clin Densitom. 2005;8:267–272
  71. Pavlov L, Gamble GD, Reid IR. Comparison of dual-energy X-ray absorptiometry and conventional radiography for the detection of vertebral fractures. J Clin Densitom. 2005;8:379–385
  72. McClung M. Osteopenia: to treat or not to treat?. Ann Intern Med. 2005;142:796–797
  73. Management of postmenopausal osteoporosis: position statement of the North American Menopause Society. Menopause. 2002;9:84–101
  74. National Osteoporosis Foundation. 2003 Physician's Guide to prevention and treatment of osteoporosis. Washington, DC.
  75. Hodgson SF, Watts NB, Bilezikian JP, et al. AACE Osteoporosis Task Force American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis. Endocr Pract. 2003;9:544–564
  76. Delmas P, Rizzoli R, Cooper C, Reginster J-Y. Treatment of patients with postmenopausal osteoporosis is worthwhile. The position of the International Osteoporosis Foundation. Osteoporos Int. 2005;16:1–5
  77. Greenspan SL, von SE, Emond SK, Jones L, Parker RA. Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom. 2001;4:373–380
  78. Greenblatt D, Jones LA, Wilson KE. Use of instant vertebral assessment in an internal medicine practice. J Bone Miner Res. 2002;17:S640
  79. Nattrass SM, Jones LA, Kelly TL, von Stetten E, Wilson KE. Vertebral fractures identified by IVA in postmenopausal women. J Bone Miner Res. 2001;16(S1):S515
  80. Cheung AM, Sinclair H, Lee Y, Hu H, Scher J, Djokoto Hawker G. Prevalence of vertebral compression deformities in a population of healthy postmenopausal women with osteopenia—data from the ECKO trial. J Clin Densitom. 2006;9(2):Poster 173 ISCD San Diego 2006
  81. Wainwright SA, Marshall LM, Ensrud KE, et al. Orwoll ES for the Study of Osteoporotic Fractures Research Group Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90:2787–2793
  82. Sornay-Rendu E, Munoz F, Garnero P, Duboeuf F, Delmas PD. Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res. 2005;20:1813–1819
  83. Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C The Osteoporosis Methodology Group. Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev. 2002;23(4):570–578
  84. Chesnut CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004;19:1241–1249
  85. Schousboe JT, Nyman JA, Kane RL, Ensrud KE. Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med. 2005;142:734–741
  86. Schousboe JT, Ensrud KE, Nyman JA, Kane RL, Melton LJ. Cost-effectiveness of vertebral fracture assessment to detect prevalent vertebral deformity and select postmenopausal women with a femoral neck T-score > -2.5 for alendronate therapy: a modeling study. J Clin Densitom. 2006;9:133–143
  87. Newman ED, Olenginski TP, Perruquet JL, Hummer M. Vertebral fracture analysis using DXA—a clinically important and inexpensive method to improve osteoporosis risk stratification. Arthritis Rheum. 2005;52(Suppl):1833
  88. Siminoski K, Warshawski RS, Jen H, Lee K. The accuracy of historical height loss for the detection of vertebral fractures in postmenopausal women. Osteoporos Int. 2006;17:290–296
  89. Siminoski K, Jiang G, Adachi JD, et al. Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures. Osteoporos Int. 2005;16:403–410
  90. Vogt TM, Ross PD, Palermo L, et al. Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group. Mayo Clin Proc. 2000;75:888–896

PII: S1094-6950(07)00161-8

doi: 10.1016/j.jocd.2007.04.002

Journal of Clinical Densitometry
Volume 10, Issue 3 , Pages 227-238 , July 2007