BlueCross BlueShield of Tennessee Medical Policy Manual

Vertebral Fracture Assessment with Densitometry


Vertebral Fracture Assessment (VFA) is a specialized software or additional component to a central dual energy x-ray absorptiometry (DEXA or DXA) scan. VFA with densitometry is a technique to assess vertebral fractures at the same time as bone mineral density (BMD), by use of dual-energy x-ray absorptiometry (DXA). The addition of vertebral fracture assessment to BMD has been proposed as additional information on a subject’s risk of fracture, or as a screening technique for individuals who may be at high risk for vertebral fractures. Several DEXA or DXA scanners with specialized software (e.g., Lunar iDXA™) are able to perform vertebral fractures assessment at the same time as a bone mineral density measurement.

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, radiation exposure, and the fact that a traditional x-ray would require a separate procedure.




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

The 2014 National Osteoporosis Foundation guidelines recommend this technology for all women and men age 50 and older with certain risk factors. However, there is a lack of direct evidence from screening trials comparing densitometry with and without vertebral fracture assessment (VFA). In addition, clinical input was not uniformly in support of VFA. Therefore, screening for vertebral fractures using VFA with dual-energy x-ray absorptiometry is considered investigational.



American College of Preventive Medicine. (2009). Screening for osteoporosis in the adult U. S. population: ACPM position statement on preventive practice. Retrieved December 12, 2013 from

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

BlueCross BlueShield Association. Medical Policy Reference Manual. (9:2016).Vertebral fracture assessment with densitometry (6.01.44). Retrieved April 19, 2017 from BlueWeb. (18 articles and/or guidelines reviewed)

First Coast Service Options, Inc. (2016, October) Local Coverage Determination (LCD): Bone Mineral Density Studies (L36356). Retrieved April 19, 2017 from:

International Society for Clinical Densitometry. (Oct-Dec, 2013). The official positions of the International Society for Clinical Densitometry: vertebral fracture assessment. Retrieved June 23, 2016 from the National Guideline Clearinghouse (NGC: 48212).

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 Institute for Health and Care Excellence (Published 2016, August; Updated 2017, February) Osteoporosis: assessing the risk of fragility fracture. Retrieved April 19, 2017 from:

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

U. S. Food and Drug Administration. (October 2005) Center for Devices and Radiologic Health. 510(k) Premarket Notification Database K052581. Retrieved July 27, 2015 from:

U. S. Preventive Services Task Force. (2011). Screening for osteoporosis. Retrieved July 27, 2015 from 

Watts, N., and Manson, J. (2017, January) Osteoporosis and fracture risk evaluation and management: shared decision making in clinical practice.Journal of the American Medical Association. Vol 317, Number 3, p253-4. (Level 5 evidence)




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