In 276 (33%) of these patients, we found one or more vertebral fractures. In 156

of these patients (54% of those who had a radiograph), this fracture—81 of which were moderate or severe—was unknown to the patient, indicating that either the fracture had occurred after the previous X-ray examination or the X-ray results had not been communicated to the patient. In the 138 patients known to have a vertebral fracture based on previous X-rays, VFA confirmed this in 129 (93%). An extensive sub study focused on detailed VX-765 cell line comparison of VFA with radiographs in a Selleck AZD6244 subgroup has been published CB-839 in vivo elsewhere [10]. BMD and VFA results As expected, a relationship was found between the BMD and the prevalence of vertebral fractures (Table 4). In the entire cohort 28% of the patients had a normal BMD. In this subgroup a vertebral fracture

was still found using VFA in 14% (97/678) that was unknown in 74%. Osteopenia was found in 45% of the cohort, and in 21% (229/1,100) of that subgroup a vertebral fracture was detected, that was unknown in 71%. Osteoporosis was diagnosed in 27% of the cohort. In 33% (215/646) of these patients, a vertebral fracture was found, that was unknown in 65%. Table 4 Bone mineral density classification and the prevalence of vertebral fractures (VF) BMD class N (% total) N with VF (% class) N with only mild VF (% VF) VF unknown (% BMD class) Normal 678 (28%) 97 (14%) 46 (47%) 74 Osteopenia 1,100 (45%) 229 (21%) 104 (45%) 71 Osteoporosis 646

(27%) 215 (33%) 69 (32%) 65 The frequency of patient with at least one severe fracture was 9% (12/135) in those with normal BMD, rose to 36% (48/135) in those with osteopenia Cyclin-dependent kinase 3 and to 56% (75/135) in those with osteoporosis, indicating that not only the frequency but also the severity of the fractures increased with decreasing BMD. Impact of VFA In the first 1,000 patients we aimed to send a questionnaire to the requesting physicians to obtain their initial and obviously subjective opinion of the BMD and VFA findings. In 58 patients, VFA results were technically inadequate and therefore 942 questionnaires were sent out. Of these, 468 were received back (50% response rate). Results are reported in Table 5.