title: Use of anthropometric indicators in screening for undiagnosed vertebral fractures: a cross-sectional analysis of the Fukui Osteoporosis Cohort (FOC) study.
abstract: BACKGROUND
  Vertebral fractures are the most common type of osteoporotic fracture. Although often asymptomatic, each vertebral fracture increases the risk of additional fractures. Development of a safe and simple screening method is necessary to identify individuals with asymptomatic vertebral fractures.
  
  
  METHODS
  Lateral imaging of the spine by single energy X-ray absorptiometry and vertebral morphometry were conducted in 116 Japanese women (mean age: 69.9 +/- 9.3 yr). Vertebral deformities were diagnosed by the McCloskey-Kanis criteria and were used as a proxy for vertebral fractures. We evaluated whether anthropometric parameters including arm span-height difference (AHD), wall-occiput distance (WOD), and rib-pelvis distance (RPD) were related to vertebral deformities. Positive findings were defined for AHD as > or = 4.0 cm, for WOD as > or = 5 mm, and for RPD as < or = two fingerbreadths. Receiver operating characteristics curves analysis was performed, and cut-off values were determined to give maximum difference between sensitivity and false-positive rate. Expected probabilities for vertebral deformities were calculated using logistic regression analysis.
  
  
  RESULTS
  The mean AHD for those participants with and without vertebral deformities were 7.0 +/- 4.1 cm and 4.2 +/- 4.2 cm (p < 0.01), respectively. Sensitivity and specificity for use of AHD-positive, WOD-positive and RPD-positive values in predicting vertebral deformities were 0.85 (95% CI: 0.69, 1.01) and 0.52 (95% CI: 0.42, 0.62); 0.70 (95% CI: 0.50, 0.90) and 0.67 (95% CI: 0.57, 0.76); and 0.67 (95% CI: 0.47, 0.87) and 0.59 (95% CI: 0.50, 0.69), respectively. The sensitivity, specificity, and likelihood ratio for a positive result (LR) for use of combined AHD-positive and WOD-positive values were 0.65 (95% CI: 0.44, 0.86), 0.81 (95% CI: 0.73, 0.89), and 3.47 (95% CI: 3.01, 3.99), respectively. The expected probability of vertebral deformities (P) was obtained by the equation; P = 1-(exp [-1.327-0.040 x body weight +1.332 x WOD-positive + 1.623 x AHD-positive])-1. The sensitivity, specificity and LR for use of a 0.306 cut-off value for probability of vertebral fractures were 0.65 (95% CI: 0.44, 0.86), 0.87 (95% CI: 0.80, 0.93), and 4.82 (95% CI: 4.00, 5.77), respectively.
  
  
  CONCLUSIONS
  Both WOD and AHD effectively predicted vertebral deformities. This screening method could be used in a strategy to prevent additional vertebral fractures, even when X-ray technology is not available.
authors.affiliation: Department of Public Health, Kinki University School of Medicine, Osaka-sayama, Japan. gac-abe@sage.ocn.ne.jp
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Abe
authors.forename: Junko
authors.initials: J
authors.lastname: Tamaki
authors.forename: Eiko
authors.initials: E
authors.lastname: Kadowaki
authors.forename: Yuho
authors.initials: Y
authors.lastname: Sato
authors.forename: Akemi
authors.initials: A
authors.lastname: Morita
authors.forename: Misa
authors.initials: M
authors.lastname: Komatsu
authors.forename: Sayaka
authors.initials: S
authors.lastname: Takeuchi
authors.forename: Etsuko
authors.initials: E
authors.lastname: Kajita
authors.forename: Masayuki
authors.initials: M
authors.lastname: Iki
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D000886:Anthropometry / Q000379:methods*; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D011237:Predictive Value of Tests; D013121:Spinal Curvatures / Q000175:diagnosis / Q000209:etiology; D016103:Spinal Fractures / Q000175:diagnosis*; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D015415:Biomarkers