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 (e.g., GE Lunar DXA Bone Densitometers with enCORE, Aria, TBS iNsight). VFA differs from radiologic detection of fractures because VFA uses a lower radiation exposure and can detect only fractures, while traditional radiograph images can detect other bone and soft tissue abnormalities in addition to spinal fractures. Manufacturers have also referred to this procedure as instant vertebral assessment, dual-energy vertebral assessment, or lateral vertebral assessment.

Only 20% to 30% of vertebral fractures are recognized clinically; the rest are discovered incidentally on lateral spine radiographs. Lateral spine radiographs have not been recommended as a component of risk assessment for osteoporosis due to cost, radiation exposure, and the fact that the radiograph would require a separate procedure in addition to the bone mineral density study using dual-energy x-ray absorptiometry.




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. (2020). Clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis - 2020. Retrieved February 15, 2021 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. (10:2020).Vertebral fracture assessment with densitometry (6.01.44). Retrieved February 15, 2021 from (22 articles and/or guidelines reviewed)

Deleskog, L., Laursen, N.Ø., Nielsen, B.R., & Schwarz, P.  (2016). Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis. Osteoporosis International, 27 (7), 2317–2326. Abstract retrieved March 24, 2020 from PubMed database.

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)

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




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