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Influence of baseline deformity definition on subsequent vertebral fracture risk in postmenopausal women

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Abstract

Introduction

Approaches for recognizing vertebral fractures remain controversial.

Methods

An age-stratified population sample of 512 postmenopausal women was followed with serial radiographs for up to 12 years (4455 person-years).

Results

112 women experienced a new vertebral fracture (20% reduction in any vertebral height from baseline) within this study period, for an annual age-adjusted (to US white women ≥50 years of age in 2000) incidence of 23 per 1000. Depending on the morphometric definition used, the prevalence of vertebral deformities at baseline ranged from 3 to 90%. A recent method to standardize vertebral heights produced the best agreement with a qualitative clinical reading of the films [kappa (κ), 0.53]. Almost all of the different baseline definitions predicted future vertebral fractures, but most of the predictive power was attributable to the severe (e.g., 4 SD) deformities included within more generous (e.g., 3 SD) classifications. Whereas the generous definitions were more sensitive, and the restrictive ones more specific, their overall abilities to predict a new vertebral fracture were roughly comparable as evaluated by the c-index (analogous to the area under an ROC curve).

Conclusion

This result suggests that the choice of a morphometry definition depends on the particular application and, in particular, on whether it is more important to maximize sensitivity or specificity.

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Acknowledgements

This project was supported in part by grants AR-27065 and AR-30582 from the National Institutes of Health, U.S. Public Health Service. Digitization of the radiographs was partly supported by a grant from Merck, Sharp and Dohme Research Laboratories. The authors would like to thank Diana Hansen and Margaret Holets for digitizing the radiographs and Mary Roberts for help in preparing the manuscript.

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Authors and Affiliations

  1. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA

    L. J. Melton III

  2. Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn., USA

    D. E. Wenger

  3. Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn., USA

    E. J. Atkinson & S. J. Achenbach

  4. Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn., USA

    L. J. Melton III & B. L. Riggs

  5. Division of Clinical Sciences, University of Sheffield, Sheffield, UK

    G. Jiang & R. Eastell

  6. Department of Radiology, Mayo Clinic College of Medicine, Jacksonville, FL, USA

    T. H. Berquist

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  1. L. J. Melton III
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  7. G. Jiang
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Correspondence to L. J. Melton III.

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Melton, L.J., Wenger, D.E., Atkinson, E.J. et al. Influence of baseline deformity definition on subsequent vertebral fracture risk in postmenopausal women. Osteoporos Int 17, 978–985 (2006). https://doi.org/10.1007/s00198-006-0106-1

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  • DOI: https://doi.org/10.1007/s00198-006-0106-1

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