Ross P D, Davis J W, Epstein R S, Wasnich R D
Epidemiology Section, Hawaii Osteoporosis Center, Honolulu 96814.
Calcif Tissue Int. 1992 Aug;51(2):95-9. doi: 10.1007/BF00298495.
It has been proposed that vertebral dimensions be used to objectively identify vertebral fractures, permitting standardization of methodology for comparisons between studies. In this report, we evaluate the ability of various vertebral dimensions and ratios to identify "abnormal" vertebrae. As no "gold standard" exists for prevalent vertebral fractures, we examined the ability of cross-sectional dimensions (at a single point in time) to detect fractured vertebrae that had been identified from changes in dimensions compared with previous radiographs. Theoretically, a cutoff of 3 SD below the mean will rarely misclassify normal vertebrae as fractured (specificity = 99.9%). However, we found that this cutoff correctly identified only about 70% of the incident fractures. A less stringent criterion (2 SD below the mean; theoretical specificity = 97.7%) identified about 85-90% of true fractures. Dividing by stature or other vertebral heights sometimes yielded marginal improvements in the ability of the anterior or posterior height dimensions to diagnose fractures. The results suggest that the true fracture prevalence may sometimes be substantially higher than suggested by cross-sectional vertebral measurements.
有人提议使用椎体尺寸来客观识别椎体骨折，从而使研究之间的比较方法标准化。在本报告中，我们评估了各种椎体尺寸和比率识别“异常”椎体的能力。由于目前尚无针对现患椎体骨折的“金标准”，我们研究了横断面尺寸（在单个时间点）检测与先前X线片相比尺寸有变化的骨折椎体的能力。理论上，低于平均值3个标准差的截断值很少会将正常椎体误判为骨折椎体（特异性=99.9%）。然而，我们发现该截断值仅能正确识别约70%的新发骨折。一个不太严格的标准（低于平均值2个标准差；理论特异性=97.7%）能识别约85%-90%的真正骨折。用身高或其他椎体高度进行除法运算有时会在前部或后部高度尺寸诊断骨折的能力上产生些许改善。结果表明，真正的骨折患病率有时可能比横断面椎体测量结果所显示的要高得多。
