What method is commonly used to screen for vertebral fractures in osteoporosis?

• A. Vertebral fracture assessment (VFA) during DXA, with spine radiographs if indicated by symptoms or signs like height loss.
• B. MRI of the spine for all patients.
• C. CT scan of the spine.
• D. Physical exam alone.

Answer: (A)

Vertebral fracture assessment during a DXA scan is the standard way to screen for vertebral fractures in osteoporosis. This approach uses the same low-dose X-ray equipment to take a side view of the thoracic and lumbar spine while you’re getting bone density testing, so you can look for fractures that people may not notice—vertebral fractures are often asymptomatic but still indicate higher fracture risk. Doing VFA during DXA is efficient, reduces extra radiation exposure, and is cost-effective because it combines fracture screening with bone density assessment in one visit.

If the VFA suggests a fracture, or if there are signs like height loss, new back pain, or abnormal kyphosis, spine radiographs are obtained to confirm the fracture and to assess the exact level and morphology. MRI and CT aren’t used for routine screening due to higher cost and, in the case of CT, higher radiation, with MRI reserved for evaluating complications or when nerve involvement is suspected. A physical exam alone isn’t reliable for diagnosing vertebral fractures because many fractures don’t produce obvious findings.