title: Prediction models of prevalent radiographic vertebral fractures among older men.
abstract: No studies have compared how well different prediction models discriminate older men who have a radiographic prevalent vertebral fracture (PVFx) from those who do not. We used area under receiver operating characteristic curves and a net reclassification index to compare how well regression-derived prediction models and nonregression prediction tools identify PVFx among men age ≥65 yr with femoral neck T-score of -1.0 or less enrolled in the Osteoporotic Fractures in Men Study. The area under receiver operating characteristic for a model with age, bone mineral density, and historical height loss (HHL) was 0.682 compared with 0.692 for a complex model with age, bone mineral density, HHL, prior non-spine fracture, body mass index, back pain, grip strength, smoking, and glucocorticoid use (p values for difference in 5 bootstrapped samples 0.14-0.92). This complex model, using a cutpoint prevalence of 5%, correctly reclassified only a net 5.7% (p = 0.13) of men as having or not having a PVFx compared with a simple criteria list (age ≥ 80 yr, HHL >4 cm, or glucocorticoid use). In conclusion, simple criteria identify older men with PVFx and regression-based models. Future research to identify additional risk factors that more accurately identify older men with PVFx is needed.
authors.affiliation: Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA. Electronic address: scho0600@umn.edu.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Harold R
authors.initials: HR
authors.lastname: Rosen
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Vokes
authors.affiliation: Department of Epidemiology, Graduate school of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, CA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.affiliation: Division of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nevitt
authors.affiliation: Division of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
authors.affiliation: Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Orwoll
authors.affiliation: Departments of Family and Preventive Medicine and Internal Medicine, University of California at San Diego, San Diego, CA, USA.
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Kado
authors.affiliation: Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA and Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000453:epidemiology; D015992:Body Mass Index; D015519:Bone Density; D005938:Glucocorticoids / Q000627:therapeutic use; D018737:Hand Strength; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology*
chemical_list: D005938:Glucocorticoids
keywords: Bone densitometry; model discrimination; prediction models; prevalent vertebral fracture; vertebral fracture assessment