Fink Howard A, Milavetz Donna L, Palermo Lisa, Nevitt Michael C, Cauley Jane A, Genant Harry K, Black Dennis M, Ensrud Kristine E
Geriatric Research Education and Clinical Center, VA Medical Center, Minneapolis, Minnesota 55417, USA.
J Bone Miner Res. 2005 Jul;20(7):1216-22. doi: 10.1359/JBMR.050314. Epub 2005 Mar 21.
We prospectively examined, in a large cohort of older women, the proportion of incident radiographic vertebral deformities diagnosed as incident clinical vertebral fractures in the same women at the same vertebral level. The proportion of deformities clinically diagnosed ranged from <15% for milder deformities to nearly 30% for more severe deformities.
The relationship between radiographic and clinical vertebral fractures is incompletely understood. No previous study has prospectively compared the agreement between incident radiographic vertebral deformities and incident community-recognized, radiographically confirmed vertebral fractures in the same women at the same vertebral level(s).
This analysis of data from the Fracture Intervention Trial included all participants who completed both baseline and at least one scheduled follow-up lateral spinal radiograph (n = 6084). Incident vertebral deformities were defined at a given vertebral level as a reduction between baseline and closeout radiographs of > or = 20% and 4 mm in any vertebral height and subdivided into two severity categories. Incident clinical vertebral fractures were those reported to clinical centers by participants and confirmed by the study radiologist, who compared the community spinal radiograph with the participant's baseline study radiograph using semiquantitative methods.
A total of 446 incident radiographic vertebral deformities were identified in 330 women, whereas 121 women experienced one or more confirmed incident clinical vertebral fracture. Of incident radiograpic vertebral deformities, 22.6% were also clinically diagnosed as incident vertebral fractures, with clinical diagnoses made for 28.4% of the deformities that exceeded 30% and 4 mm height loss (severe deformity) compared with 14.3% for deformities that involved > or = 20% and 4 mm but < 30% height loss (milder deformity). Of incident clinical vertebral fractures, 72.7% were morphometrically identified as incident deformities, most of them as severe deformities. More than 20% of incident clinical fractures were not identified as incident deformities by even the most liberal morphometric criterion used in this study.
Approximately one-fourth of incident radiographic vertebral deformities were clinically diagnosed as new vertebral fractures, although the proportion clinically diagnosed was increased for more severe deformities. Whereas most incident clinical vertebral fractures were identified as severe morphometric deformities, approximately one-fourth did not meet even the most liberal study criterion for morphometric deformity. Further study of factors that may explain the discordance between incident vertebral deformities and incident clinical vertebral fractures is important.
我们在一大群老年女性中进行了前瞻性研究，以探究在同一女性的同一椎体水平上，被诊断为新发临床椎体骨折的影像学椎体畸形的比例。临床诊断出的畸形比例，从较轻畸形的不到15%到较严重畸形的近30%不等。
影像学椎体骨折与临床椎体骨折之间的关系尚未完全明确。此前没有研究前瞻性地比较过同一女性在同一椎体水平上，新发影像学椎体畸形与社区认可的、经影像学证实的新发椎体骨折之间的一致性。
对骨折干预试验的数据进行的这项分析，纳入了所有完成基线检查和至少一次预定随访脊柱侧位X线片的参与者（n = 6084）。在给定椎体水平上，新发椎体畸形定义为基线X线片与末次X线片相比，任何椎体高度减少≥20%且4毫米，并细分为两个严重程度类别。新发临床椎体骨折是参与者向临床中心报告并经研究放射科医生确认的骨折，放射科医生使用半定量方法将社区脊柱X线片与参与者的基线研究X线片进行比较。
在330名女性中总共识别出446例新发影像学椎体畸形，而121名女性经历了一次或多次经确认的新发临床椎体骨折。在新发影像学椎体畸形中，22.6%也被临床诊断为新发椎体骨折，对于超过30%且高度丢失4毫米（严重畸形）的畸形，临床诊断比例为28.4%，而对于涉及≥20%且4毫米但<30%高度丢失（较轻畸形）的畸形，临床诊断比例为14.3%。在新发临床椎体骨折中，72.7%在形态学上被识别为新发畸形，其中大多数为严重畸形。即使采用本研究中最宽松的形态学标准，超过20%的新发临床骨折也未被识别为新发畸形。
约四分之一的新发影像学椎体畸形被临床诊断为新的椎体骨折，尽管较严重畸形的临床诊断比例有所增加。虽然大多数新发临床椎体骨折被识别为严重形态学畸形，但约四分之一的骨折甚至未达到本研究中最宽松的形态学畸形标准。进一步研究可能解释新发椎体畸形与新发临床椎体骨折之间不一致的因素很重要。
