title: A critical appraisal of vertebral fracture assessment in paediatrics.
abstract: OBJECTIVE
  There is a need to improve our understanding of the clinical utility of vertebral fracture assessment (VFA) in paediatrics and this requires a thorough evaluation of its readability, reproducibility, and accuracy for identifying VF.
  
  
  METHODS
  VFA was performed independently by two observers, in 165 children and adolescents with a median age of 13.4 years (range, 3.6, 18). In 20 of these subjects, VFA was compared to lateral vertebral morphometry assessment on lateral spine X-ray (LVM).
  
  
  RESULTS
  1528 (84%) of the vertebrae were adequately visualised by both observers for VFA. Interobserver agreement in vertebral readability was 94% (kappa, 0.73 [95% CI, 0.68, 0.73]). 93% of the non-readable vertebrae were located between T6 and T9. Interobserver agreement per-vertebra for the presence of VF was 99% (kappa, 0.85 [95% CI, 0.79, 0.91]). Interobserver agreement per-subject was 91% (kappa, 0.78 [95% CI, 0.66, 0.87]). Per-vertebra agreement between LVM and VFA was 95% (kappa 0.79 [95% CI, 0.62, 0.92]) and per-subject agreement was 95% (kappa, 0.88 [95% CI, 0.58, 1.0]). Accepting LVM as the gold standard, VFA had a positive predictive value (PPV) of 90% and a negative predictive value (NPV) of 95% in per-vertebra analysis and a PPV of 100% and NPV of 93% in per-subject analysis.
  
  
  CONCLUSIONS
  VFA reaches an excellent level of agreement between observers and a high level of accuracy in identifying VF in a paediatric population. The readability of vertebrae at the mid thoracic region is suboptimal and interpretation at this level should be exercised with caution.
authors.affiliation: Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: Andreas.Kyriakou@glasgow.ac.uk.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kyriakou
authors.affiliation: Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: Sheila.Shepherd@glasgow.ac.uk.
authors.forename: Sheila
authors.initials: S
authors.lastname: Shepherd
authors.affiliation: Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: avrilmason@nhs.net.
authors.forename: Avril
authors.initials: A
authors.lastname: Mason
authors.affiliation: Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom. Electronic address: faisal.ahmed@glasgow.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Faisal Ahmed
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods / Q000592:standards*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D016103:Spinal Fractures / Q000000981:diagnostic imaging*
keywords: DXA; Dual energy X-ray absorptiometry; LVM; Lateral vertebral morphometry; Paediatric osteoporosis; Vertebral fractures