Fechtenbaum J, Cropet C, Kolta S, Verdoncq B, Orcel P, Roux C
Department of Rheumatology, Paris 5 University AP-HP Cochin Hospital, 27 rue du Faubourg, Saint Jacques, 75014, Paris, France.
Osteoporos Int. 2005 Dec;16(12):1823-6. doi: 10.1007/s00198-005-1939-8. Epub 2005 Jul 20.
Vertebral fractures are the hallmark of osteoporosis, responsible for increased morbidity and mortality in post-menopausal women. However, two-thirds of vertebral fractures do not come to clinical attention. The aim of this study was to compare the identification of vertebral fractures on spine X-rays among rheumatologists. Study subjects were women aged 60-80 years having potential signs of vertebral fracture and visiting a rheumatologist. X-rays were performed according to standardized procedures. In 629 patients (among 824 included) at least one vertebral fracture was diagnosed, and the X-rays were then sent to a central facility where a semi-quantitative assessment of vertebral fracture was performed by a single rheumatologist trained for this evaluation. According to the vertebral level, kappa scores were between 0.20 to 0.77, i.e., below 0.6 from T4 to T7, and between 0.6 and 0.77 from T8 to L4. The false-negative fractures rate was 25.8% (and 15.7% of them were related to a numbering discrepancy). The rate of false positive fractures was 6.3%. At the patient level 6.8% had actually no fracture. This study shows that 25% of overall vertebral fractures are not diagnosed among patients considered as having at least one fracture. As a consequence, patients who require treatment to reduce fracture risk are not being properly identified.
椎体骨折是骨质疏松症的标志，会导致绝经后女性的发病率和死亡率上升。然而，三分之二的椎体骨折未引起临床关注。本研究的目的是比较风湿病学家对脊柱X光片上椎体骨折的识别情况。研究对象为年龄在60至80岁之间、有椎体骨折潜在迹象且就诊于风湿病学家的女性。X光片按照标准化程序进行拍摄。在629名患者（纳入的824名患者中）中诊断出至少一处椎体骨折，然后将X光片送至一个中心机构，由一名接受过此项评估培训的风湿病学家对椎体骨折进行半定量评估。根据椎体水平，kappa评分在0.20至0.77之间，即从T4到T7低于0.6，从T8到L4在0.6至0.77之间。假阴性骨折率为25.8%（其中15.7%与编号差异有关）。假阳性骨折率为6.3%。在患者层面，6.8%的患者实际上没有骨折。这项研究表明，在被认为至少有一处骨折的患者中，25%的椎体骨折未被诊断出来。因此，需要进行治疗以降低骨折风险的患者未得到正确识别。
