BlueCross BlueShield of Tennessee Medical Policy Manual

Vertebral Fracture Assessment with Densitometry


Vertebral Fracture Assessment (VFA) with densitometry is a technique to assess vertebral fractures at the same time as bone mineral density, using additional software with dual-energy x-ray absorptiometry. The addition of vertebral fracture assessment to BMD has been proposed as a technique to diagnose whether an individual has a vertebral fracture. Additional software is necessary to perform VFA with a densitometer and several products have received FDA clearance (e.g., Lunar Dual Energy Vertebral Assessment [DVA™] and Instant Vertebral Assessment [IVA™].

Only 20–30% of vertebral fractures are recognized clinically, and they are highly prevalent in the elderly population. The standard technology for diagnosing vertebral fractures is lateral spine x-rays. Lateral spine x-rays have not been recommended as a component of risk assessment for osteoporosis because of the cost and radiation exposure.




The most recent recommendation from the U. S. Preventive Services Task Force on screening for osteoporosis does not address this technology.


American Association of Clinical Endocrinologists and American College of Endocrinology. (2016). Clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis – 2016. Retrieved April 17, 2019 from

American College of Radiology. (2016). ACR appropriateness criteria® osteoporosis and bone mineral density. Retrieved June 23, 2016 from

BlueCross BlueShield Association. Evidence Positioning System. (9:2018).Vertebral fracture assessment with densitometry (6.01.44). Retrieved April 8, 2019 from (22 articles and/or guidelines reviewed)

Lee, J.H., Lee, Y.K., Oh, S.H., Ahn, J., Lee, Y.E., Pyo, J.H., et al. (2016). A systematic review of diagnostic accuracy of vertebral fracture assessment (VFA) in postmenopausal women and elderly men. Osteoporosis International, 27 (5), 1691-1699. Abstract retrieved April 17, 2019 from PubMed database.

Muszkat, P., Camargo, M., Peters, B., Kunii, I., & Lazaretti-Castro, M. (2015). Digital vertebral morphometry performed by DXA: a valuable opportunity for identifying fractures during bone mass assessment. Archives of Endocrinology and Metabolism, 59 (2), 1-10. (Level 4 evidence)

National Osteoporosis Foundation. (April 2014). Clinician's guide to prevention and treatment of osteoporosis. Retrieved July 24, 2015 from 

U. S. Preventive Services Task Force. (2018). Osteoporosis to prevent fractures: screening. Retrieved April 17, 2019 from 




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