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Osteoporotic Vertebral Fracture Prevalence Varies Widely Between Qualitative and Quantitative Radiological Assessment Methods: The Rotterdam Study.
- Source :
-
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research [J Bone Miner Res] 2018 Apr; Vol. 33 (4), pp. 560-568. Date of Electronic Publication: 2017 Sep 06. - Publication Year :
- 2018
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Abstract
- Accurate diagnosis of vertebral osteoporotic fractures is crucial for the identification of individuals at high risk of future fractures. Different methods for radiological assessment of vertebral fractures exist, but a gold standard is lacking. The aim of our study was to estimate statistical measures of agreement and prevalence of osteoporotic vertebral fractures in the population-based Rotterdam Study, across two assessment methods. The quantitative morphometry assisted by SpineAnalyzer® (QM SA) method evaluates vertebral height loss that affects vertebral shape whereas the algorithm-based qualitative (ABQ) method judges endplate integrity and includes guidelines for the differentiation of vertebral fracture and nonfracture deformities. Cross-sectional radiographs were assessed for 7582 participants aged 45 to 95 years. With QM SA, the prevalence was 14.2% (95% CI, 13.4% to 15.0%), compared to 4.0% (95% CI, 3.6% to 4.5%) with ABQ. Inter-method agreement according to kappa (κ) was 0.24. The highest agreement between methods was among females (κ = 0.31), participants age >80 years (κ = 0.40), and at the L <subscript>1</subscript> level (κ = 0.40). With ABQ, most fractures were found at the thoracolumbar junction (T <subscript>12</subscript> -L <subscript>1</subscript> ) followed by the T <subscript>7</subscript> -T <subscript>8</subscript> level, whereas with QM SA, most deformities were in the mid thoracic (T <subscript>7</subscript> -T <subscript>8</subscript> ) and lower thoracic spine (T <subscript>11</subscript> -T <subscript>12</subscript> ), with similar number of fractures in both peaks. Excluding mild QM SA deformities (grade 1 with QM) from the analysis increased, the agreement between the methods from κ = 0.24 to 0.40, whereas reexamining mild deformities based on endplate depression increased agreement from κ = 0.24 to 0.50 (p <0.001). Vertebral fracture prevalence differs significantly between QM SA and ABQ; reexamining QM mild deformities based on endplate depression would increase the agreement between methods. More widespread and consistent application of an optimal method may improve clinical care. © 2017 American Society for Bone and Mineral Research.<br /> (© 2017 American Society for Bone and Mineral Research.)
Details
- Language :
- English
- ISSN :
- 1523-4681
- Volume :
- 33
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
- Publication Type :
- Academic Journal
- Accession number :
- 28719143
- Full Text :
- https://doi.org/10.1002/jbmr.3220