Ferrar L, Jiang G, Armbrecht G, Reid D M, Roux C, Glüer C C, Felsenberg D, Eastell R
Academic Unit of Bone Metabolism, Division of Clinical Sciences (North), University of Sheffield, Sheffield, UK.
Bone. 2007 Jul;41(1):5-12. doi: 10.1016/j.bone.2007.03.015. Epub 2007 Apr 4.
Diagnosis of prevalent osteoporotic vertebral fracture is complicated by normal or developmental variation in vertebral shape or size and non-osteoporotic deformities that appear to have 'reduced' height. Using our visual approach, the algorithm-based qualitative method (ABQ) a vertebra with apparent "reduced" height without evidence of osteoporotic endplate depression is classified as non-osteoporotic short vertebral height (SVH). We aimed to determine whether ABQ classification of SVH represents true or false negative diagnosis of osteoporotic vertebral fracture, by testing the associations with clinical outcomes of osteoporosis or vertebral fracture.
The ABQ method was used to assess spinal radiographs acquired at baseline for a subset of 904 postmenopausal women participating in the Osteoporosis and Ultrasound Study (OPUS). The sample was enriched with vertebral fracture cases. Subjects were categorized by ABQ diagnosis as (i) normal, (ii) non-osteoporotic short vertebral height (SVH) or (iii) osteoporotic vertebral fracture.
Women were classified by ABQ as follows: osteoporotic vertebral fracture, n=231; SVH, n=376 and normal, n=297. Women with vertebral fracture were older, with lower height, weight and height loss than those classified as SVH or normal. Women with SVH were heavier and older, with greater historical height loss than normal women. Age-adjusted SD units (z-scores) for BMD were lower than expected among women with osteoporotic vertebral fracture, but not among those with SVH. There was a significant association between diagnosis of osteoporotic vertebral fracture and history of low-trauma non-vertebral and vertebral fracture (p<0.001, odds ratios=3.2 and 20.6, respectively). There was also an association between diagnosis of SVH and previous low-trauma non-vertebral fracture (p<0.05, odds ratio=1.7).
Short vertebral height without evidence of central endplate fracture in postmenopausal women is largely unrelated to osteoporosis. Quantitative morphometry should not be used alone for the assessment of vertebral fracture in clinical decision making: we recommend differential diagnosis of morphometric vertebral deformities by an expert reader to rule out non-osteoporotic deformities with short vertebral height.
由于椎体形状或大小的正常或发育变异以及看似椎体高度“降低”的非骨质疏松性畸形，使得常见骨质疏松性椎体骨折的诊断变得复杂。使用我们的视觉方法，即基于算法的定性方法（ABQ），对于椎体高度明显“降低”且无骨质疏松性终板凹陷证据的椎体，分类为非骨质疏松性短椎体高度（SVH）。我们旨在通过测试与骨质疏松症或椎体骨折临床结局的关联，来确定ABQ对SVH的分类代表骨质疏松性椎体骨折的真阴性还是假阴性诊断。
采用ABQ方法评估参与骨质疏松症与超声研究（OPUS）的904名绝经后女性亚组在基线时获取的脊柱X线片。该样本富含椎体骨折病例。根据ABQ诊断将受试者分为：（i）正常，（ii）非骨质疏松性短椎体高度（SVH）或（iii）骨质疏松性椎体骨折。
根据ABQ分类，女性情况如下：骨质疏松性椎体骨折，n = 231；SVH，n = 376；正常，n = 297。椎体骨折女性比分类为SVH或正常的女性年龄更大，身高、体重和身高降低幅度更小。SVH女性比正常女性体重更重、年龄更大，既往身高降低幅度更大。骨质疏松性椎体骨折女性的骨密度年龄校正标准差单位（z评分）低于预期，但SVH女性并非如此。骨质疏松性椎体骨折诊断与低创伤非椎体和椎体骨折病史之间存在显著关联（p < 0.001，比值比分别为3.2和20.6）。SVH诊断与既往低创伤非椎体骨折之间也存在关联（p < 0.05，比值比 = 1.7）。
绝经后女性中无中央终板骨折证据的短椎体高度在很大程度上与骨质疏松症无关。在临床决策中，定量形态测量不应单独用于评估椎体骨折：我们建议由专业阅片者对形态测量性椎体畸形进行鉴别诊断，以排除非骨质疏松性短椎体高度畸形。
