Osteoporosis International

, Volume 17, Issue 2, pp 290–296

The accuracy of historical height loss for the detection of vertebral fractures in postmenopausal women

Original Article

Abstract

Historical height loss (HHL) can be calculated as the difference between a patient’s tallest recalled height (TRH) and the current measured height (MH). We have examined the accuracy of HHL as a clinical test for the detection of prevalent vertebral fractures. Subjects were postmenopausal women aged 50 or older who had been referred for specialist assessment of osteoporosis risk ( n =323; average age 66.0±9.2 years; range 50–92 years). MH was determined using a wall-mounted stadiometer. The presence of prevalent vertebral fractures was assessed by radiographic morphometry, with fracture defined as a vertebral height ratio <0.8. The positive likelihood ratio (LR+) for fracture was relatively flat until HHL >6.0 cm. With HHL from 6.1 to 8.0 cm, the LR+ was 2.8 [95% confidence interval (95%CI), 1.3, 6.0]. When HHL was >8.0 cm, the LR+ was 9.8 (95% CI, 3.0, 31.8). The area under the receiver operating characteristics curve for the ability of HHL to detect fracture was 0.66 (95% CI, 0.59, 0.72). At HHL >6.0 cm, sensitivity was 30% (95% CI, 22, 37%), and specificity was 94% (95% CI, 90, 97%). The positive predictive value was relatively low across a range of theoretical prevalence, rising above 80% only at very high prevalence rates (>50%). In contrast, the negative predictive value was high at the prevalence rates seen in most clinical practice, and dropped below 80% only when the prevalence exceeded 25%. This study shows that HHL ≤6.0 cm rules out prevalent vertebral fracture with a high degree of accuracy; patients with HHL >6.0 cm should have spine radiographs to examine for the presence of vertebral fractures.

Keywords

Anthropometry Osteoporosis Stadiometer Stature Vertebral fracture 

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • K. Siminoski
    • 1
    • 2
  • R. S. Warshawski
    • 1
  • H. Jen
    • 1
  • K. Lee
    • 1
  1. 1.Department of Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonCanada
  2. 2.Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of AlbertaEdmontonCanada

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