Epidemiology, Identification Rate and Treatment Penetration of Osteoporotic Vertebral Fractures in Switzerland
Condition: Postmenopausal Osteoporosis; Spinal Fractures
MeSH terms: Osteoporosis; Osteoporosis, Postmenopausal; Fractures, Bone; Spinal Fractures
Study type: Observational

Summary: 
      In Switzerland, the prevalence of vertebral fractures in community- dwelling women is unknown
      and the published data from the Swiss hospitals statistics represent only the tip of the
      iceberg. In addition, the percentages of women correctly identified with vertebral fractures
      due to osteoporosis and the treatment rate of these women with a drug proven to reduce the
      risk of further fractures are unknown. Furthermore, it is not known whether the prevalence of
      vertebral fractures differs between urban and rural areas or between mountain areas and plain
      country, e.g. due to possible differences in sun exposure (vitamin D production) and/ or in
      physical activity and/ or dietary habits.

      Clinical signs and symptoms leading to the suspicion of vertebral fracture(s) lack either
      sensitivity (wall-occiput distance) or specificity (rib-pelvis distance). Whether a
      combination of both would improve sensitivity and specificity is unknown.

      The gold standard for the diagnosis of vertebral fracture relies on antero-posterior and
      lateral X-Rays of the thoracic and lumbar spine. Despite standardization of X-Ray readings, a
      retrospective study of hospitalized elderly patients has shown that as many as 50% of the
      radiographic reports failed to note the presence of moderate to severe vertebral fractures.
      In a primary care setting, fewer than 2% of the women received diagnoses of osteoporosis or
      vertebral fracture, although expected prevalence is 20% to 30% and appropriate drug treatment
      was offered to only 36% of the diagnosed patients.

      The recent availability of software for vertebral fracture assessment (VFA) coupled to DXA
      measurements allows for the detection of vertebral deformities, which is critical for
      management of osteoporosis, as the existence of such deformities substantially increases the
      risk of subsequent fracture. Recently published results show that VFA allows the diagnosis of
      a vertebral fracture. The sensitivity of VFA for detection of vertebral fractures compared to
      expert radiologist reading of X-ray is excellent for grade 2 and 3 fractures, ranging between
      90-94%.
    

Detailed description: 
      Examinations

        -  Community-dwelling women from a random sample (address lists may be chosen from public
           and/ or private providers)

        -  Aged 65-79 yrs

        -  Written informed consent
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The study population will be based on a representative (age categories, urban vs. rural,
        plain vs. mountain) stratified random sample taken from the general population of women
        living in urban/ suburban and country/ mountain regions (stratified for n = one third each,
        based on city code) in the german speaking part of Switzerland.
      
Biospecimen description: 
      serum
    
Keywords: vertebral fracture assessment (vfa); vitamin D