Journal of Bone and Mineral Metabolism

, Volume 32, Issue 5, pp 533–538 | Cite as

Detective value of historical height loss and current height/knee height ratio for prevalent vertebral fracture in Japanese postmenopausal women

Original Article


Vertebral fracture (VFx) is associated with various co-morbidities and increased mortality. In this paper, we have studied the detective value of height loss for VFx using two indices; historical height loss (HHL) which is the difference between the maximal height, and the current height (CH), and CH/knee height (KH) ratio. One-hundred and fifty-one postmenopausal women visiting the outpatient clinic of orthopaedics were studied for their CH, self-reported maximal height, KH, and radiographically diagnosed VFx number(s). VFx was present in 41.1 % of the subjects. Multiple regression analyses revealed that the number of prevalent fractures was a significant predictor of HHL and CH/KH ratio. Receiver operator characteristic curve analysis has shown that for HHL, the area under the curve (AUC) with their 95 %CI in the parentheses was 0.84 (0.77, 0.90), 0.88 (0.83, 0.94), and 0.91 (0.86, 0.96) for ≥1, ≥2, and ≥3 fractures, respectively. For the presence of ≥1 VFx, the cut-off value was 4.0 cm (specificity 79 %; sensitivity 79 %). Regarding the CH/KH ratio, AUC was 0.73 (0.65, 0.82), 0.85 (0.78, 0.93), and 0.91 (0.86, 0.96) for ≥1, ≥2, and ≥3 fractures, respectively. For the presence of ≥1 VFx, the cut-off value was 3.3 (specificity 47 %; sensitivity 91 %). Both cut-off values for HHL and CH/KH ratio had high negative predictivity across the wide range of theoretical VFx prevalence. Thus, HHL and CH/KH were both good detectors of VFx. Our data would be the basis to determine the cut-off value for the screening or case finding of subjects with VFx.


Historical height loss Knee height Vertebral fracture Japanese postmenopausal women 


  1. 1.
    Miyakoshi N, Kasukawa Y, Sasaki H, Kamo K, Shimada Y (2009) Impact of spinal kyphosis on gastroesophageal reflux disease symptoms in patients with osteoporosis. Osteoporos Int 20:1193–1198PubMedCrossRefGoogle Scholar
  2. 2.
    Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456PubMedCrossRefGoogle Scholar
  3. 3.
    Graat-Verboom L, Smeenk FW, van den Borne BE, Spruit MA, Donkers-van Rossum AB, Aarts RP, Wouters EF (2012) Risk factors for osteoporosis in Caucasian patients with moderate chronic obstructive pulmonary disease: a case control study. Bone 50:1234–1239PubMedCrossRefGoogle Scholar
  4. 4.
    Dam TT, Harrison S, Fink HA, Ramsdell J, Barrett-Connor E, Osteoporotic Fractures in Men (MrOS) Research Group (2010) Bone mineral density and fractures in older men with chronic obstructive pulmonary disease or asthma. Osteoporos Int 21:1341–1349PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Martin AR, Sornay-Rendu E, Chandler JM, Duboeuf F, Girman CJ, Delmas PD (2002) The impact of osteoporosis on quality-of-life: the OFELY cohort. Bone 31:32–36PubMedCrossRefGoogle Scholar
  6. 6.
    Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Kellingray S, Leplege A, Liberman UA, McCloskey E, Minne H, Reeve J, Reginster JY, Scholz M, Todd C, de Vernejoul MC, Wiklund I (1999) Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporos Int 10:150–160PubMedCrossRefGoogle Scholar
  7. 7.
    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392PubMedCrossRefGoogle Scholar
  8. 8.
    Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos EA, Hopman W, Poliquin S, Prior JC, Hanley DA, Olszynski WP, Anastassiades T, Brown JP, Murray T, Jackson SA, Tenenhouse A, Canadian Multicentre Osteoporosis Study (CaMos) Research Group (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12:903–908PubMedCrossRefGoogle Scholar
  9. 9.
    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRefGoogle Scholar
  10. 10.
    Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O, European Vertebral Osteoporosis Study (2003) Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int 14:61–68PubMedCrossRefGoogle Scholar
  11. 11.
    Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561PubMedCrossRefGoogle Scholar
  12. 12.
    Lee YK, Jang S, Jang S, Lee HJ, Park C, Ha YC, Kim DY (2012) Mortality after vertebral fracture in Korea: analysis of the National Claim Registry. Osteoporos Int 23:1859–1865PubMedCrossRefGoogle Scholar
  13. 13.
    van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629PubMedCrossRefGoogle Scholar
  14. 14.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  15. 15.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. J Am Med Assoc 285:320–323CrossRefGoogle Scholar
  16. 16.
    Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382PubMedCrossRefGoogle Scholar
  17. 17.
    McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14:1028–1034PubMedCrossRefGoogle Scholar
  18. 18.
    Wallace I, Callachand F, Elliott J, Gardiner P (2011) An evaluation of an enhanced fracture liaison service as the optimal model for secondary prevention of osteoporosis. JRSM Short Rep 10:8CrossRefGoogle Scholar
  19. 19.
    Lauritzen JB, Schwarz P, Lund B, McNair P, Transbøl I (1993) Changing incidence and residual lifetime risk of common osteoporosis-related fractures. Osteoporos Int 3:127–132PubMedCrossRefGoogle Scholar
  20. 20.
    Vogt TM, Ross PD, Palermo L, Musliner T, Genant HK, Black D, Thompson DE (2000) Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group. Mayo Clin Proc 75:888–896PubMedCrossRefGoogle Scholar
  21. 21.
    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 17:290–296PubMedCrossRefGoogle Scholar
  22. 22.
    Kaptoge S, Armbrecht G, Felsenberg D, Lunt M, O’Neill TW, Silman AJ, Reeve J, EPOS Study Group (2004) When should the doctor order a spine X-ray? Identifying vertebral fractures for osteoporosis care: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 19:1982–1993PubMedCrossRefGoogle Scholar
  23. 23.
    North American Menopause Society (2006) Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause 13:340–367CrossRefGoogle Scholar
  24. 24.
    Huang C, Ross PD, Lydick E, Davis JW, Wasnich RD (1996) Contributions of vertebral fractures to stature loss among elderly Japanese-American women in Hawaii. J Bone Miner Res 11:408–411PubMedCrossRefGoogle Scholar
  25. 25.
    Chumlea WC, Guo SS, Steinbaugh ML (1994) Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. J Am Diet Assoc 94:1385–1388PubMedCrossRefGoogle Scholar
  26. 26.
    Cockram DB, Baumgartner RN (1990) Evaluation of accuracy and reliability of calipers for measuring recumbent knee height in elderly people. Am J Clin Nutr 52:397–400PubMedGoogle Scholar
  27. 27.
    Bland JM, Altman G (1996) Statistics notes: measurement error. Br Med J 313:744CrossRefGoogle Scholar
  28. 28.
    Lee RD, Nieman DC (2007) Nutritional assessment, 4th edn. McGraw-Hill, New YorkGoogle Scholar
  29. 29.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRefGoogle Scholar
  30. 30.
    Mori S, Soen S, Hagino H, Nakano T, Ito M, Fujiwara S, Kato Y, Tokuhashi Y, Togawa D, Endo N, Sawaguchi T (2013) Diagnostic criteria of vertebral fracture. Osteoporos Jpn 21:25–32Google Scholar
  31. 31.
    Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96:644–647PubMedCrossRefGoogle Scholar
  32. 32.
    Orimo H (ed) (2011) Japanese Guidelines for the Prevention and Treatment of Osteoporosis, 2011 edition (in Japanese). Life Science Publishing, TokyoGoogle Scholar
  33. 33.
    Briot K, Legrand E, Pouchain D, Monnier S, Roux C (2010) Accuracy of patient-reported height loss and risk factors for height loss among postmenopausal women. CMAJ 182:558–562PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Ismail AA, Cooper C, Felsenberg D, Varlow J, Kanis JA, Silman AJ, O’Neill TW (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European Vertebral Osteoporosis Study Group. Osteoporos Int 9:206–213PubMedCrossRefGoogle Scholar
  35. 35.
    Siminoski K, Jiang G, Adachi JD, Hanley DA, Cline G, Ioannidis G, Hodsman A, Josse RG, Kendler D, Olszynski WP, Ste Marie LG, Eastell R (2005) Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures. Osteoporos Int 16:403–410PubMedCrossRefGoogle Scholar
  36. 36.
    Kleerekoper M, Nelson DA, Peterson EL, Tilley BC (1992) Outcome variables in osteoporosis trials. Bone 13(suppl):S29–S34PubMedCrossRefGoogle Scholar
  37. 37.
    Nores JM, Remy JM, Nenna AD (1990) The value of span measurements in osteoporosis. Br J Clin Pracr 44:154Google Scholar
  38. 38.
    Cline MG, Meredith KE, Boyer JT, Burrows B (1989) Decline of height with age in adults in a general population sample: estimating maximum height and distinguishing birth cohort effects from actual loss of stature with aging. Hum Biol 61:415–425PubMedGoogle Scholar
  39. 39.
    Bunout D, Barrera G, de la Maza MP, Leiva L, Gattas V, Hirsch S (2007) Height reduction, determined using knee height measurement as a risk factor or predictive sign for osteoporosis in elderly women. Nutrition 23:794–797PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2013

Authors and Affiliations

  1. 1.Sasayama Medical CenterHyogo Medical CollegeSasayamaJapan
  2. 2.Department of Health and NutritionOsaka Shoin Women’s UniversityHigashiosakaJapan
  3. 3.Department of Food and NutritionKyoto Women’s UniversityKyotoJapan

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