BlueCross BlueShield of Tennessee Medical Policy Manual

Vertebral Fracture Assessment with Densitometry

DESCRIPTION

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.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

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

SOURCES 

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 www.aace.com.

American College of Radiology. (2016). ACR appropriateness criteria® osteoporosis and bone mineral density. Retrieved June 23, 2016 from https://acsearch.acr.org.

BlueCross BlueShield Association. Evidence Positioning System. (9:2018).Vertebral fracture assessment with densitometry (6.01.44). Retrieved April 8, 2019 from https://www.evidencepositioningsystem.com/. (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 http://nof.org. 

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

ORIGINAL EFFECTIVE DATE:  9/9/2012

MOST RECENT REVIEW DATE:  5/9/2019

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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