Abstract
Summary
This study examined the accuracy of thoracic and lumbar kyphotic angles as well as anthropometric indicators for discriminating patients with vertebral fracture among Japanese women >50 years old with back pain. Along with region-specific kyphotic angles and anthropometric indicators, the combination of thoracic and lumbar kyphotic angles offered the highest accuracy.
Introduction
Vertebral fractures have been associated with thoracic kyphosis. However, reports on lumbar kyphotic changes in association with vertebral fracture are scarce. This study investigated the accuracy of thoracic kyphotic angle (TKA) and lumbar kyphotic angle (LKA) measurements as well as anthropometric indicators (wall–occiput distance (WOD) and rib–pelvis distance (RPD)) in discriminating patients with vertebral fracture.
Methods
Lateral radiographs of the spine were obtained in 70 postmenopausal Japanese women who visited an orthopedic clinic with low back pain (mean age, 76.2 ± 9.0 years). Radiographic vertebral fracture was diagnosed using quantitative measurement according to Japanese criteria. Osteoarthritis (OA) was defined as Kellgren–Lawrence (KL) grade 3 or higher. TKA and LKA were measured using SpinalMouse®. WOD and RPD were also measured.
Results
At least one vertebral fracture was present in 49 subjects (70 %). Women with vertebral fractures showed significant increases in LKA, TKA + LKA, and WOD and decreases in RPD. Logistic regression analysis showed significant association between TKA + LKA and vertebral fracture independent of the presence of OA. Receiver operating characteristic analysis revealed that TKA was useful for discriminating thoracic fractures (area under the curve (AUC), 0.730) and LKA was useful for lumbar fractures (AUC, 0.691). The combination of TKA + LKA offered the highest accuracy for detecting thoracic, lumbar, and any vertebral fractures, with AUCs of 0.779, 0.728, and 0.783, respectively. WOD and RPD showed low-to-moderate accuracies for thoracic, lumbar, and any vertebral fractures.
Conclusions
Assessment of spinal kyphosis by SpinalMouse® as well as anthropometric indicators proved useful in discriminating subjects with vertebral fractures. These convenient and radiation-free methods could contribute to early diagnosis of vertebral fractures and subsequent appropriate treatment, thus preventing additional osteoporotic fractures.
Similar content being viewed by others
References
Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215
Clark P, Cons-Molina F, Deleze M et al (2009) The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos Int 20:275–282
Sadat-Ali M, Gullenpet AH, Al-Mulhim F, Al Turki H, Al-Shammary H, Al-Elq A, Al-Othman A (2009) Osteoporosis-related vertebral fractures in postmenopausal women: prevalence in a Saudi Arabian sample. East Mediterr Health J 15:1420–1425
Lunt M, O’Neill TW, Felsenberg D, Reeve J, Kanis JA, Cooper C, Silman AJ (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513
Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923
Kitahara H, Ye Z, Aoyagi K et al (2012) Associations of vertebral deformities and osteoarthritis with back pain among Japanese women: the Hizen-Oshima study. Osteoporos Int 24:907–915
Rikli R, Jones C (1999) Development and validation of a functional fitness test for community-residing older adults. J Aging Phys Act 7:129–161
Antonelli-Incalzi R, Pedone C, Cesari M, Di Iorio A, Bandinelli S, Ferrucci L (2007) Relationship between the occiput-wall distance and physical performance in the elderly: a cross sectional study. Aging Clin Exp Res 19:207–212
O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018
Spector TD, McCloskey EV, Doyle DV, Kanis JA (1993) Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford Study. J Bone Miner Res 8:817–822
Fechtenbaum J, Cropet C, Kolta S, Verdoncq B, Orcel P, Roux C (2005) Reporting of vertebral fractures on spine X-rays. Osteoporos Int 16:1823–1826
McKiernan FE (2009) The broadening spectrum of osteoporotic vertebral fracture. Skeletal Radiol 38:303–308
Siminoski K, Warshawski RS, Jen H, Lee KC (2011) The accuracy of clinical kyphosis examination for detection of thoracic vertebral fractures: comparison of direct and indirect kyphosis measures. J Musculoskelet Neuronal Interact 11:249–256
Abe K, Tamaki J, Kadowaki E, Sato Y, Morita A, Komatsu M, Takeuchi S, Kajita E, Iki M (2008) Use of anthropometric indicators in screening for undiagnosed vertebral fractures: a cross-sectional analysis of the Fukui Osteoporosis Cohort (FOC) study. BMC Musculoskelet Disord 9:157
Vosse D, van der Heijde D, Landewe R, Geusens P, Mielants H, Dougados M, van der Linden S (2006) Determinants of hyperkyphosis in patients with ankylosing spondylitis. Ann Rheum Dis 65:770–774
Culham EG, Jimenez HA, King CE (1994) Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis. Spine 19:1250–1255
Leidig-Bruckner G, Minne HW, Schlaich C, Wagner G, Scheidt-Nave C, Bruckner T, Gebest HJ, Ziegler R (1997) Clinical grading of spinal osteoporosis: quality of life components and spinal deformity in women with chronic low back pain and women with vertebral osteoporosis. J Bone Mineral Res: Off J Am Soc Bone Mineral Res 12:663–675
Siminoski K, Warshawski RS, Jen H, Lee KC (2003) Accuracy of physical examination using the rib-pelvis distance for detection of lumbar vertebral fractures. Am J Med 115:233–236
Cortet B, Roches E, Logier R, Houvenagel E, Gaydier-Souquieres G, Puisieux F, Delcambre B (2002) Evaluation of spinal curvatures after a recent osteoporotic vertebral fracture. Joint Bone Spine 69:201–208
De Smet AA, Robinson RG, Johnson BE, Lukert BP (1988) Spinal compression fractures in osteoporotic women: patterns and relationship to hyperkyphosis. Radiology 166:497–500
Ensrud KE, Black DM, Harris F, Ettinger B, Cummings SR (1997) Correlates of kyphosis in older women. The Fracture Intervention Trial Research Group. J Am Geriatr Soc 45:682–687
Roux C, Fechtenbaum J, Kolta S, Said-Nahal R, Briot K, Benhamou CL (2010) Prospective assessment of thoracic kyphosis in postmenopausal women with osteoporosis. J Bone Mineral Res: Off J Am Soc Bone Mineral Res 25:362–368
Schneider DL, von Muhlen D, Barrett-Connor E, Sartoris DJ (2004) Kyphosis does not equal vertebral fractures: the Rancho Bernardo study. J Rheumatol 31:747–752
Huang MH, Barrett-Connor E, Greendale GA, Kado DM (2006) Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Mineral Res: Off J Am Soc Bone Mineral Res 21:419–423
Krause M, Breer S, Mohrmann B, Vettorazzi E, Marshall RP, Amling M, Barvencik F (2013) Influence of non-traumatic thoracic and lumbar vertebral fractures on sagittal spine alignment assessed by radiation-free spinometry. Osteoporos Int: J Established Result Cooperation Between Eur Found Osteoporos Nat Osteoporos Foun USA 24:1859–1868
Post RB, Leferink VJ (2004) Spinal mobility: sagittal range of motion measured with the SpinalMouse, a new non-invasive device. Arch Orthop Trauma Surg 124:187–192
Miyakoshi N, Hongo M, Maekawa S, Ishikawa Y, Shimada Y, Okada K, Itoi E (2005) Factors related to spinal mobility in patients with postmenopausal osteoporosis. Osteoporos Int 16:1871–1874
Mannion AF, Knecht K, Balaban G, Dvorak J, Grob D (2004) A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature. Eur Spine J: Off Publ Eur Spine Soc, Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc 13:122–136
Gallagher JC, Hedlund LR, Stoner S, Meeger C (1988) Vertebral morphometry: normative data. Bone Miner 4:189–196
Spencer N, Steiger P, Cummings S, Genant H (1990) Placement of points for digitizing spine films. J Bone Miner Res 5:s247
Mori S, Soen S, Hagino H et al (2013) Justification criteria for vertebral fractures: year 2012 revision. J Bone Miner Metab 31:258–261
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502
Yoshimura N, Muraki S, Oka H, Mabuchi A, Kinoshita H, Yosihda M, Kawaguchi H, Nakamura K, Akune T (2009) Epidemiology of lumbar osteoporosis and osteoarthritis and their causal relationship—is osteoarthritis a predictor for osteoporosis or vice versa?: the Miyama study. Osteoporos Int 20:999–1008
Green AD, Colon-Emeric CS, Bastian L, Drake MT, Lyles KW (2004) Does this woman have osteoporosis? JAMA 292:2890–2900
Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20:1351–1358
Milne JS, Lauder IJ (1974) Age effects in kyphosis and lordosis in adults. Ann Hum Biol 1:327–337
Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601
Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y (2009) Spinal curvature and postural balance in patients with osteoporosis. Osteoporos Int 20:2049–2053
Tobias JH, Hutchinson AP, Hunt LP, McCloskey EV, Stone MD, Martin JC, Thompson PW, Palferman TG, Bhalla AK (2007) Use of clinical risk factors to identify postmenopausal women with vertebral fractures. Osteoporos Int: J Established Result Cooperation Between Eur Found Osteoporos Nat Osteoporos Found USA 18:35–43
Balzini L, Vannucchi L, Benvenuti F, Benucci M, Monni M, Cappozzo A, Stanhope SJ (2003) Clinical characteristics of flexed posture in elderly women. J Am Geriatr Soc 51:1419–1426
Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE (2010) Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther 40:352–360
Sinaki M, Itoi E, Rogers JW, Bergstralh EJ, Wahner HW (1996) Correlation of back extensor strength with thoracic kyphosis and lumbar lordosis in estrogen-deficient women. Am J Phys Med Rehabil/Assoc Acad Physiatrists 75:370–374
Acknowledgments
The authors would like to thank the subjects and staff at the participating hospital for allowing us to conduct this study.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mizukami, S., Abe, Y., Tsujimoto, R. et al. Accuracy of spinal curvature assessed by a computer-assisted device and anthropometric indicators in discriminating vertebral fractures among individuals with back pain. Osteoporos Int 25, 1727–1734 (2014). https://doi.org/10.1007/s00198-014-2680-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-014-2680-y