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Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures

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Abstract

Vertebral fractures are the most common type of osteoporotic fracture, but more than two-thirds remain undetected. We have examined the relationship between height loss and the development of new vertebral fractures to determine whether there is a height loss threshold that has useful clinical accuracy to detect new fractures. We studied 985 postmenopausal women with osteoporosis in the placebo arms of the Vertebral Efficacy with Risedronate Therapy studies. Height was measured annually for 3 years using a wall-mounted stadiometer. New fractures were determined using quantitative and semi-quantitative radiographic morphometry. The relationship between height loss over three years and the number of new vertebral fractures was: height loss (cm)=0.95×number of new vertebral fractures−0.4 cm (r=0.33). The odds ratio for the development of a new fracture increased up to 20.6 (95% confidence interval, 9.3, 45.8) when height loss was greater than 4.0 cm. At a threshold of >2.0 cm height loss over 3 years, sensitivity was 35.5% for detecting new vertebral fractures and specificity was 93.6%. These findings show that there is a strong relationship between the amount of height loss and the risk of a new vertebral fracture. While there is no cut-off that can reliably rule in a new fracture, height loss of ≤2.0 cm over 1–3 years has acceptable accuracy for ruling out an incident fracture.

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Acknowledgements

The authors would like to thank John Banner of Procter & Gamble Pharmaceuticals for his excellent advice and assistance in matters statistical. Financial support for the VERT studies was provided by Procter & Gamble Pharmaceuticals and Aventis Pharma. The VERT sponsors gave access to the data in the placebo groups of the VERT studies, and provided statistical expertise (Dr. Cline). The authors were solely responsible for data analysis and interpretation and preparation of the publication.

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Correspondence to K. Siminoski.

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Siminoski, K., Jiang, G., Adachi, J.D. et al. Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures. Osteoporos Int 16, 403–410 (2005). https://doi.org/10.1007/s00198-004-1709-z

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  • DOI: https://doi.org/10.1007/s00198-004-1709-z

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