Height loss, vertebral fractures, and the misclassification of osteoporosis.
BACKGROUND
The presence of a vertebral fracture identifies a patient who has clinical osteoporosis. However, approximately 2/3 to 3/4 of VFs are asymptomatic. Vertebral Fracture Assessment is a method derived from dual-energy X-ray absorptiometry (DXA) to assess vertebral fractures. The objectives of this study were 1) to determine the association between the degree of height loss in older men and women and the risk of a vertebral fracture, and 2) to determine if the knowledge of vertebral fractures will alter the classification of osteoporosis based on bone mineral density alone.


METHODS
231 men and women over the age of 65 underwent DXA scan of their spine and hip (including bone mineral density and Vertebral Fracture Assessment), measurement of their height, and a questionnaire.


RESULTS
We found that height loss was significantly associated with a vertebral fracture (p=0.0160). The magnitude of the association translates to a 19% increase in odds for 1/2 in. and 177% for 3 in. Although 45% had osteoporosis by either bone mineral density or fracture criteria, 30% would have been misclassified if bone mineral density criteria were used alone.


CONCLUSIONS
Height loss is an indicator for the presence of vertebral fractures. Bone mineral density criteria alone may misclassify older patients who have osteoporosis.
Xu
WanWan
W
Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Perera
Subashan
S
Medich
Donna
D
Fiorito
Gail
G
Wagner
Julie
J
Berger
Loretta K
LK
Greenspan
Susan L
SL
D000368:Aged; D000369:Aged, 80 and over; D001827:Body Height / Q000502:physiology*; D002118:Calcium / Q000008:administration & dosage; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D010024:Osteoporosis / Q000145:classification* / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D012907:Smoking; D016103:Spinal Fractures / Q000453:epidemiology*; D014807:Vitamin D / Q000008:administration & dosage
D014807:Vitamin D; D002118:Calcium