Skip to main content

Advertisement

SpringerLink
Log in

Validity of height loss as a predictor for prevalent vertebral fractures, low bone mineral density, and vitamin D deficiency

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Many osteoporosis-related vertebral fractures are unappreciated but their detection is important as their presence increases future fracture risk. We found height loss is a useful tool in detecting patients with vertebral fractures, low bone mineral density, and vitamin D deficiency which may lead to improvements in patient care.

Introduction

This study aimed to determine if/how height loss can be used to identify patients with vertebral fractures, low bone mineral density, and vitamin D deficiency.

Methods

A hospital database search in which four patient groups including those with a diagnosis of osteoporosis-related vertebral fracture, osteoporosis, osteopenia, or vitamin D deficiency and a control group were evaluated for chart-documented height loss over an average 3 1/2 to 4-year time period. Data was retrieved from 66,021 patients (25,792 men and 40,229 women).

Results

A height loss of 1, 2, 3, and 4 cm had a sensitivity of 42, 32, 19, and 14% in detecting vertebral fractures, respectively. Positive likelihood ratios for detecting vertebral fractures were 1.73, 2.35, and 2.89 at 2, 3, and 4 cm of height loss, respectively. Height loss had lower sensitivities and positive likelihood ratios for detecting low bone mineral density and vitamin D deficiency compared to vertebral fractures. Specificity of 1, 2, 3, and 4 cm of height loss was 70, 82, 92, and 95%, respectively. The odds ratios for a patient who loses 1 cm of height being in one of the four diagnostic groups compared to a patient who loses no height was higher for younger and male patients.

Conclusions

This study demonstrated that prospective height loss is an effective tool to identify patients with vertebral fractures, low bone mineral density, and vitamin D deficiency although a lack of height loss does not rule out these diagnoses. If significant height loss is present, the high positive likelihood ratios support a further workup.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Peter RS, Fromm E, Klenk J, Concin H, Nagel G (2014) Change in height, weight, and body mass index: longitudinal data from Austria. Am J Hum Biol 26(5):690–696

    Article  PubMed  Google Scholar 

  2. Galbusera F, van Rijsbergen M, Ito K, Huyghe JM, Brayda-Bruno M, Wilke HJ (2014) Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility. Eur Spine J 23(Suppl 3):S324–S332

    PubMed  Google Scholar 

  3. Greenspan SL, von Stetten E, Emond SK, Jones L, Parker RA (2001) Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom 4(4):373–380

    Article  CAS  PubMed  Google Scholar 

  4. Xu W, Perera S, Medich D et al (2011) Height loss, vertebral fractures, and the misclassification of osteoporosis. Bone 48(2):307–311

    Article  PubMed  Google Scholar 

  5. Cosman F, de Beur SJ, LeBoff MS et al (2014) Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 25(10):2359–2381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry. J Clin Densitom 16(4):455–466

    Article  PubMed  Google Scholar 

  7. Melton LJ 3rd, Atkinson EJ, Cooper C, O'Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10(3):214–221

    Article  PubMed  Google Scholar 

  8. Kendler DL, Bauer DC, Davison KS et al (2016) Vertebral fractures: clinical importance and management. Am J Med 129(2):221.e221–221.e210

    Article  Google Scholar 

  9. Miller PD (2016) Clinical management of vertebral compression fractures. J Clin Densitom 19(1):97–101

    Article  PubMed  Google Scholar 

  10. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312(7041):1254–1259

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Maier GS, Seeger JB, Horas K, Roth KE, Kurth AA, Maus U (2015) The prevalence of vitamin D deficiency in patients with vertebral fragility fractures. Bone Joint J 97-b(1):89–93

    Article  CAS  PubMed  Google Scholar 

  12. Youden WJ (1950) Index for rating diagnostic tests. Cancer 3(1):32–35

    Article  CAS  PubMed  Google Scholar 

  13. Waterloo S, Ahmed LA, Center JR et al (2012) Prevalence of vertebral fractures in women and men in the population-based Tromso study. BMC Musculoskelet Disord 13:3

    Article  PubMed  PubMed Central  Google Scholar 

  14. McGee S (2002) Simplifying likelihood ratios. J Gen Intern Med 17(8):647–650

    Article  PubMed Central  Google Scholar 

  15. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767

    Article  PubMed  Google Scholar 

  16. Siminoski K, Warshawski RS, Jen H, Lee K (2006) The accuracy of historical height loss for the detection of vertebral fractures in postmenopausal women. Osteoporos Int 17(2):290–296

    Article  CAS  PubMed  Google Scholar 

  17. Tobias JH, Hutchinson AP, Hunt LP et al (2007) Use of clinical risk factors to identify postmenopausal women with vertebral fractures. Osteoporos Int 18(1):35–43

    Article  CAS  PubMed  Google Scholar 

  18. Jayawardene W, Lohrmann D, Youssef AA (2014) Discrepant body mass index: behaviors associated with height and weight misreporting among US adolescents from the National Youth Physical Activity and nutrition study. Child Obes 10(3):225–233

    Article  PubMed  Google Scholar 

  19. Hsiao H, Weaver D, Hsiao J et al (2014) Comparison of measured and self-reported anthropometric information among firefighters: implications and applications. Ergonomics 57(12):1886–1897

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yoon K, Jang SN, Chun H, Cho SI. Self-reported anthropometric information cannot vouch for the accurate assessment of obesity prevalence in populations of middle-aged and older Korean individuals. Arch Gerontol Geriatr 2014.

  21. Mikula AL, Hetzel SJ, Binkley N, Anderson PA. Clinical height measurements are unreliable: a call for improvement. Osteoporos Int 2016.

  22. Gunnes M, Lehmann EH, Mellstrom D, Johnell O (1996) The relationship between anthropometric measurements and fractures in women. Bone 19(4):407–413

    Article  CAS  PubMed  Google Scholar 

  23. Moayyeri A, Luben RN, Bingham SA, Welch AA, Wareham NJ, Khaw KT (2008) Measured height loss predicts fractures in middle-aged and older men and women: the EPIC-Norfolk prospective population study. J Bone Miner Res 23(3):425–432

    Article  PubMed  Google Scholar 

  24. Kaptoge S, Armbrecht G, Felsenberg D et al (2006) Whom to treat? The contribution of vertebral X-rays to risk-based algorithms for fracture prediction. Results from the European prospective osteoporosis study. Osteoporos Int 17(9):1369–1381

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    A. L. Mikula

  2. Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    S. J. Hetzel

  3. Department of Medicine–Geriatrics, University of Wisconsin, Madison, WI, USA

    N. Binkley

  4. Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Ave, 6th Floor, Madison, WI, 53705, USA

    P. A. Anderson

Authors
  1. A. L. Mikula
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. J. Hetzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Binkley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. A. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. A. Anderson.

Ethics declarations

Conflicts of interest

None.

Electronic supplementary material

ESM 1

(DOCX 102 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mikula, A.L., Hetzel, S.J., Binkley, N. et al. Validity of height loss as a predictor for prevalent vertebral fractures, low bone mineral density, and vitamin D deficiency. Osteoporos Int 28, 1659–1665 (2017). https://doi.org/10.1007/s00198-017-3937-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-3937-z

Keywords

Search

Navigation