Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS)

L. Ferrar, G. Jiang, G. Armbrecht, D. M. Reid, C. Roux, C. C. Gluer, D. Felsenberg, R. Eastell

Research output: Contribution to journalArticle

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Abstract

Introduction and hypothesis: Diagnosis of prevalent osteoporotic vertebral fracture is complicated by normal or developmental variation in vertebral shape or size and non-osteoporotic deformities that appear to have 'reduced' height. Using our visual approach, the algorithm-based qualitative method (ABQ) a vertebra with apparent "reduced" height without evidence of osteoporotic endplate depression is classified as nonosteoporotic short vertebral height (SVH). We aimed to determine whether ABQ classification of SVH represents true or false negative diagnosis of osteoporotic vertebral fracture, by testing the associations with clinical outcomes of osteoporosis or vertebral fracture.

Methods. The ABQ method was used to assess spinal radiographs acquired at baseline for a subset of 904 postmenopausal women participating in the Osteoporosis and Ultrasound Study (OPUS). The sample was enriched with vertebral fracture cases. Subjects were categorized by ABQ diagnosis as (i) normal, (ii) non-osteoporotic short vertebral height (SVH) or (iii) osteoporotic vertebral fracture.

Results: Women were classified by ABQ as follows: osteoporotic vertebral fracture, n=231; SVH, n = 376 and normal, n=297. Women with vertebral fracture were older, with lower height, weight and height loss than those classified as SVH or normal. Women with SVH were heavier and older, with greater historical height loss than normal women. Age-adjusted SID units (z-scores) for BMD were lower than expected among women with osteoporotic vertebral fracture, but not among those with SVH. There was a significant association between diagnosis of osteoporotic vertebral fracture and history of low-trauma non-vertebral and vertebral fracture (p<0.001, odds ratios=3.2 and 20.6, respectively). There was also an association between diagnosis of SVH and previous low-trauma non-vertebral fracture (p<0.05, odds ratio= 1.7).

Conclusions: Short vertebral height without evidence of central endplate fracture in postmenopausal women is largely unrelated to osteoporosis. Quantitative morphometry should not be used alone for the assessment of vertebral fracture in clinical decision making: we recommend differential diagnosis of morphometric vertebral deformities by an expert reader to rule out non-osteoporotic deformities with short vertebral height. (C) 2007 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)5-12
Number of pages8
JournalBone
Volume41
Issue number1
Early online date4 Apr 2007
DOIs
Publication statusPublished - Jul 2007

Keywords

  • osteoporosis
  • vertebral fracture
  • bone mineral density
  • bone-mineral density
  • risk-factors
  • back-pain
  • women
  • deformities
  • population
  • identification
  • index
  • men

Cite this

Ferrar, L., Jiang, G., Armbrecht, G., Reid, D. M., Roux, C., Gluer, C. C., ... Eastell, R. (2007). Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS). Bone, 41(1), 5-12. https://doi.org/10.1016/j.bone.2007.03.015

Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS). / Ferrar, L.; Jiang, G.; Armbrecht, G.; Reid, D. M.; Roux, C.; Gluer, C. C.; Felsenberg, D.; Eastell, R.

In: Bone, Vol. 41, No. 1, 07.2007, p. 5-12.

Research output: Contribution to journalArticle

Ferrar, L, Jiang, G, Armbrecht, G, Reid, DM, Roux, C, Gluer, CC, Felsenberg, D & Eastell, R 2007, 'Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS)' Bone, vol. 41, no. 1, pp. 5-12. https://doi.org/10.1016/j.bone.2007.03.015
Ferrar, L. ; Jiang, G. ; Armbrecht, G. ; Reid, D. M. ; Roux, C. ; Gluer, C. C. ; Felsenberg, D. ; Eastell, R. / Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS). In: Bone. 2007 ; Vol. 41, No. 1. pp. 5-12.
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abstract = "Introduction and hypothesis: Diagnosis of prevalent osteoporotic vertebral fracture is complicated by normal or developmental variation in vertebral shape or size and non-osteoporotic deformities that appear to have 'reduced' height. Using our visual approach, the algorithm-based qualitative method (ABQ) a vertebra with apparent {"}reduced{"} height without evidence of osteoporotic endplate depression is classified as nonosteoporotic short vertebral height (SVH). We aimed to determine whether ABQ classification of SVH represents true or false negative diagnosis of osteoporotic vertebral fracture, by testing the associations with clinical outcomes of osteoporosis or vertebral fracture.Methods. The ABQ method was used to assess spinal radiographs acquired at baseline for a subset of 904 postmenopausal women participating in the Osteoporosis and Ultrasound Study (OPUS). The sample was enriched with vertebral fracture cases. Subjects were categorized by ABQ diagnosis as (i) normal, (ii) non-osteoporotic short vertebral height (SVH) or (iii) osteoporotic vertebral fracture.Results: Women were classified by ABQ as follows: osteoporotic vertebral fracture, n=231; SVH, n = 376 and normal, n=297. Women with vertebral fracture were older, with lower height, weight and height loss than those classified as SVH or normal. Women with SVH were heavier and older, with greater historical height loss than normal women. Age-adjusted SID units (z-scores) for BMD were lower than expected among women with osteoporotic vertebral fracture, but not among those with SVH. There was a significant association between diagnosis of osteoporotic vertebral fracture and history of low-trauma non-vertebral and vertebral fracture (p<0.001, odds ratios=3.2 and 20.6, respectively). There was also an association between diagnosis of SVH and previous low-trauma non-vertebral fracture (p<0.05, odds ratio= 1.7).Conclusions: Short vertebral height without evidence of central endplate fracture in postmenopausal women is largely unrelated to osteoporosis. Quantitative morphometry should not be used alone for the assessment of vertebral fracture in clinical decision making: we recommend differential diagnosis of morphometric vertebral deformities by an expert reader to rule out non-osteoporotic deformities with short vertebral height. (C) 2007 Elsevier Inc. All rights reserved.",
keywords = "osteoporosis, vertebral fracture, bone mineral density, bone-mineral density, risk-factors, back-pain, women, deformities, population, identification, index, men",
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T1 - Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS)

AU - Ferrar, L.

AU - Jiang, G.

AU - Armbrecht, G.

AU - Reid, D. M.

AU - Roux, C.

AU - Gluer, C. C.

AU - Felsenberg, D.

AU - Eastell, R.

PY - 2007/7

Y1 - 2007/7

N2 - Introduction and hypothesis: Diagnosis of prevalent osteoporotic vertebral fracture is complicated by normal or developmental variation in vertebral shape or size and non-osteoporotic deformities that appear to have 'reduced' height. Using our visual approach, the algorithm-based qualitative method (ABQ) a vertebra with apparent "reduced" height without evidence of osteoporotic endplate depression is classified as nonosteoporotic short vertebral height (SVH). We aimed to determine whether ABQ classification of SVH represents true or false negative diagnosis of osteoporotic vertebral fracture, by testing the associations with clinical outcomes of osteoporosis or vertebral fracture.Methods. The ABQ method was used to assess spinal radiographs acquired at baseline for a subset of 904 postmenopausal women participating in the Osteoporosis and Ultrasound Study (OPUS). The sample was enriched with vertebral fracture cases. Subjects were categorized by ABQ diagnosis as (i) normal, (ii) non-osteoporotic short vertebral height (SVH) or (iii) osteoporotic vertebral fracture.Results: Women were classified by ABQ as follows: osteoporotic vertebral fracture, n=231; SVH, n = 376 and normal, n=297. Women with vertebral fracture were older, with lower height, weight and height loss than those classified as SVH or normal. Women with SVH were heavier and older, with greater historical height loss than normal women. Age-adjusted SID units (z-scores) for BMD were lower than expected among women with osteoporotic vertebral fracture, but not among those with SVH. There was a significant association between diagnosis of osteoporotic vertebral fracture and history of low-trauma non-vertebral and vertebral fracture (p<0.001, odds ratios=3.2 and 20.6, respectively). There was also an association between diagnosis of SVH and previous low-trauma non-vertebral fracture (p<0.05, odds ratio= 1.7).Conclusions: Short vertebral height without evidence of central endplate fracture in postmenopausal women is largely unrelated to osteoporosis. Quantitative morphometry should not be used alone for the assessment of vertebral fracture in clinical decision making: we recommend differential diagnosis of morphometric vertebral deformities by an expert reader to rule out non-osteoporotic deformities with short vertebral height. (C) 2007 Elsevier Inc. All rights reserved.

AB - Introduction and hypothesis: Diagnosis of prevalent osteoporotic vertebral fracture is complicated by normal or developmental variation in vertebral shape or size and non-osteoporotic deformities that appear to have 'reduced' height. Using our visual approach, the algorithm-based qualitative method (ABQ) a vertebra with apparent "reduced" height without evidence of osteoporotic endplate depression is classified as nonosteoporotic short vertebral height (SVH). We aimed to determine whether ABQ classification of SVH represents true or false negative diagnosis of osteoporotic vertebral fracture, by testing the associations with clinical outcomes of osteoporosis or vertebral fracture.Methods. The ABQ method was used to assess spinal radiographs acquired at baseline for a subset of 904 postmenopausal women participating in the Osteoporosis and Ultrasound Study (OPUS). The sample was enriched with vertebral fracture cases. Subjects were categorized by ABQ diagnosis as (i) normal, (ii) non-osteoporotic short vertebral height (SVH) or (iii) osteoporotic vertebral fracture.Results: Women were classified by ABQ as follows: osteoporotic vertebral fracture, n=231; SVH, n = 376 and normal, n=297. Women with vertebral fracture were older, with lower height, weight and height loss than those classified as SVH or normal. Women with SVH were heavier and older, with greater historical height loss than normal women. Age-adjusted SID units (z-scores) for BMD were lower than expected among women with osteoporotic vertebral fracture, but not among those with SVH. There was a significant association between diagnosis of osteoporotic vertebral fracture and history of low-trauma non-vertebral and vertebral fracture (p<0.001, odds ratios=3.2 and 20.6, respectively). There was also an association between diagnosis of SVH and previous low-trauma non-vertebral fracture (p<0.05, odds ratio= 1.7).Conclusions: Short vertebral height without evidence of central endplate fracture in postmenopausal women is largely unrelated to osteoporosis. Quantitative morphometry should not be used alone for the assessment of vertebral fracture in clinical decision making: we recommend differential diagnosis of morphometric vertebral deformities by an expert reader to rule out non-osteoporotic deformities with short vertebral height. (C) 2007 Elsevier Inc. All rights reserved.

KW - osteoporosis

KW - vertebral fracture

KW - bone mineral density

KW - bone-mineral density

KW - risk-factors

KW - back-pain

KW - women

KW - deformities

KW - population

KW - identification

KW - index

KW - men

U2 - 10.1016/j.bone.2007.03.015

DO - 10.1016/j.bone.2007.03.015

M3 - Article

VL - 41

SP - 5

EP - 12

JO - Bone

JF - Bone

SN - 8756-3282

IS - 1

ER -