Comparison of screening strategies for prevalent vertebral fractures in South Korea: Vertebral fracture assessment vs. Spine radiography

Sung Hee Oh, Dam Kim, Young Eun Lee, Deog Yoon Kim, Yu Kyung Lee, Joo Hyun Lee, Sang Cheol Bae, Yun Young Choi, Junhee Pyo, Jeonghoon Ahn, Yoon Kyoung Sung

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5 Scopus citations


Background: Vertebral Fracture Assessment (VFA) is a useful tool to detect the vertebral fracture (VF) with low cost and radiation exposure. We aimed to compare screening strategies including VFA and spine radiography (X-ray) for detecting VF in terms of clinical effectiveness, cost and radiation exposure. Methods: Three screening strategies: 1) X-ray following VFA, 2) VFA only, and 3) X-ray only were compared using a Markov model based on administrative data from South Korea in a population aged ≥50 years. We compared the incidence of new VFs, cost-effectiveness of reducing new VFs and radiation exposure in each strategy. Results: The incidence of new VFs was reduced in all screening strategies compared to no screening: 29.4% for women and 12.5% for men in both X-ray following the VFA and VFA only strategies and 35% for women and 17.5% for men in the X-ray only strategy. The X-ray following VFA strategy had the lowest cost, followed by the X-ray only, and VFA only strategies. The radiation doses for X-ray only were 2,647-2,989 μSv and 3,253-3,398 μSv higher than in the X-ray following VFA and VFA only strategies. The new VF prevention effect was greater in women, and more prominent in older people (women ≥ 70, men ≥ 80) than people ≥ 50 years. Conclusions: The X-ray following VFA strategy is a cost-effective option for screening prevalent VF to prevent new VF in people aged ≥50 years due to its high effectiveness, lowest cost, and least radiation exposure.

Original languageEnglish
Article number46
JournalBMC Musculoskeletal Disorders
Issue number1
StatePublished - 12 Feb 2018

Bibliographical note

Funding Information:
This study was completed as part of the health technology assessment project (no. NA-2013-007) funded by the National Evidence-based Healthcare Collaborating Agency in South Korea.

Publisher Copyright:
© 2018 The Author(s).


  • Cost effectiveness
  • Diagnostic imaging
  • Radiation
  • Radiography
  • Spinal fracture


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