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The Accuracy of Prevalent Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches.

Authors
  • Ma, Jinhui1
  • Siminoski, Kerry2
  • Wang, Peiyao3
  • Alos, Nathalie4
  • Cummings, Elizabeth A5
  • Feber, Janusz6
  • Halton, Jacqueline6
  • Ho, Josephine7
  • Houghton, Kristin8
  • Lang, Bianca5
  • Miettunen, Paivi M7
  • Scuccimarri, Rosie9
  • Jaremko, Jacob L10
  • Koujok, Khaldoun11
  • Lentle, Brian12
  • Matzinger, Mary Ann11
  • Shenouda, Nazih11
  • Rauch, Frank9
  • Ward, Leanne M6
  • 1 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. , (Canada)
  • 2 Department of Radiology and Diagnostic Imaging and Department of Internal Medicine, University of Alberta, Edmonton, AB, Canada. , (Canada)
  • 3 Faculty of Science, McMaster University, Hamilton, ON, Canada. , (Canada)
  • 4 Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada. , (Canada)
  • 5 Department of Pediatrics, Dalhousie University, Halifax, NS, Canada. , (Canada)
  • 6 Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada. , (Canada)
  • 7 Department of Pediatrics, University of Calgary, Calgary, AB, Canada. , (Canada)
  • 8 Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. , (Canada)
  • 9 Department of Pediatrics, McGill University, Montreal, QC, Canada. , (Canada)
  • 10 Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada. , (Canada)
  • 11 Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada. , (Canada)
  • 12 Department of Radiology, University of British Columbia, Vancouver, BC, Canada. , (Canada)
Type
Published Article
Journal
Journal of Bone and Mineral Research
Publisher
Wiley (John Wiley & Sons)
Publication Date
Mar 01, 2020
Volume
35
Issue
3
Pages
460–468
Identifiers
DOI: 10.1002/jbmr.3922
PMID: 31742768
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform spine radiographs in most conditions that predispose to vertebral fracture (VF). In this study we examined the accuracy of two clinical predictors, back pain and lumbar spine bone mineral density (LS BMD), to derive four case-finding paradigms for detection of prevalent VF (PVF). Subjects were 400 children at risk for PVF (leukemia 186, rheumatic disorders 135, nephrotic syndrome 79). Back pain was assessed by patient report, LS BMD was measured by dual-energy X-ray absorptiometry, and PVF were quantified on spine radiographs using the modified Genant semiquantitative method. Forty-four patients (11.0%) had PVF. Logistic regression analysis between LS BMD and PVF produced an odds ratio (OR) of 1.9 (95% confidence interval [CI], 1.5 to 2.5) per reduction in Z-score unit, an area under the receiver operating characteristic curve of 0.70 (95% CI, 0.60 to 0.79), and an optimal BMD Z-score cutoff of -1.6. Case identification using either low BMD alone (Z-score < -1.6) or back pain alone gave similar results for sensitivity (55%, 52%, respectively), specificity (78%, 81%, respectively), positive predictive value (PPV; 24%, 25%, respectively), and negative predictive value (NPV; 93%, 93%, respectively). The paradigm using low BMD plus back pain produced lower sensitivity (32%), higher specificity (96%), higher PPV (47%), and similar NPV (92%). The approach using low BMD or back pain had the highest sensitivity (75%), lowest specificity (64%), lowest PPV (20%), and highest NPV (95%). All paradigms had increased sensitivities for higher fracture grades. Our results show that BMD and back pain history can be used to identify children with the highest risk of PVF so that radiography can be used judiciously. The specific paradigm to be applied will depend on the expected PVF rate and the clinical approach to the use of radiography. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.

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