Abstract
There is no agreed definition for the assessment of vertebral fractures and deformities in patients with osteoporosis. Radiographs of 66 patients randomized for therapy with etidronate or placebo were analyzed at baseline and during follow-up (60/120/150 weeks) independently using two procedures. The first method of spinal deformity index (SDIG) and vertebral deformity score (VDSG) is based on a semiquantitative visual reading of each vertebra between T4 and L4. The second method of spine deformity index (SDIM) and vertebral deformity index (VDIM) is based on vertebral height measurements of T4 through L5 and each measurement from T5 to L5 (anterior, middle and posterior height) is related to T4 and compared with the respective T4-related normal range. There was good agreement between the mean vertebral deformation from T5 to L4 graded by VDSG and VDIM, with correlation coefficients betweenR=0.52 (p<0.0001) andR=0.9 (p<0.0001) respectively. Spinal deformation at baseline as measured by SDIM and SDIG was correlated withR=0.76 (p<0.0001). For diagnosing a vertebra as fractured or not, VDIM reached a sensitivity of 82% and a specificity of 85% using VDSG as a standard, and on the other hand VDSG reached a sensitivity of 78% and a specificity of 88% in relation to VDIM. The changes in spinal deformation from week 0 to 150 were correlated withR=0.58 (p<0.0002) between SDIM and SDIG. To detect vertebral fracture progression the sensitivity of VDIM was 74% and the specificity 86%, when changes in VDSG were used as a standard. On the other hand sensitivity for VDSG was 56% and specificity 95% to detect vertebral fracture progression, when changes in VDIM were used as a standard. The comparison of changes in spinal deformation in the etidronate and placebo group during the 3-year study demonstrated that changes in SDIM during follow-up confirmed the results found by the changes in SDIG. As an independent standard for vertebral deformity and fracture definition is not available, the present study does not allow a decision as to whether semiquantitative reading (SDIG) or vertebral height measurements (SDIM) are closer to the biological truth. We conclude that in clinical studies the assessment of vertebral fractures or deformations should be validated by the comparison between two different established techniques, performed independently.
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References
Barnett E, Nordin BEC. The radiological diagnosis of osteoporosis: a new approach. Clin Radiol 1960;11:166–74.
Hurxthal LM. Measurement of anterior vertebral compressions and biconcave vertebrae. AJR 1968;103:635–44.
Horsman A. Bone mass. In: Nordin BEC, editor. Calcium, phosphate and magnesium metabolism: clinical physiology and diagnostic procedures. Edinburgh: Churchill-Livingstone, 1976: 357–404.
Kleerekoper M, Parfitt AM, Ellis J. Measurement of vertebral fracture rates in osteoporosis. In: Christiansen C, Arnaud CD, Nordin BEC, Parfitt AM, Peck WA, Riggs BL, editors. Proceedings of the Copenhagen International Symposium on Osteoporosis 1984. Copenhagen, Aalberg Stiftsbogtrykkeri, 1984:103–9.
Hedlund LR, Gallagher JC. Vertebral morphometry in diagnosis of spinal osteoporosis. Bone Miner 1988;5:59–67.
Minne HW, Leidig G, Wüster C, Siromachkostov L, Baldauf G, Bickel R, et al. A newly developed spine deformity index (SDI) to quantitate vertebral crush fractures in patients with osteoporosis. Bone Miner 1988;3:335–49.
Melton LJ, Kan SH, Frye KM, Wahner HW, O'Fallon WM, Riggs B. Epidemiology of vertebral fractures in women. Am J Epidemiol 1989;129:1000–11.
Davies KM, Recker RR, Heaney RP. Normal vertebral dimensions and normal variation in serial measurements of vertebrae. J Bone Miner Res 1989;4:341–9.
Raymakers JA, Kapelle JW, van Beresteijn ECH, Duursma SA. Assessment of osteoporotic spine deformity: a new method. Skeletal Radiol 1990;19:91–7.
Smith-Bindman R, Cummings SR, Steiger P, Genant HK. A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 1991;6:25–34.
Sauer P, Leidig G, Minne HW, Duckeck G, Schwarz W, Siromachkostov L, Ziegler R. Spine Deformity Index (SDI) versus other objective procedures of vertebral fracture identification in patients with osteoporosis: a comparative study. J Bone Miner Res 1991;6:227–38.
Hansen MA, Overgaard K, Gotfredsen A, Christiansen C. Does the prevalence of vertebral fractures increase? In: Christiansen C, Overgaard K, editors. Osteoporosis 1990, vol. 1. Copenhagen: Osteoporosis, 1990:95–7.
Nelson D, Peterson E, Tilley B, O'Fallon WM, Chao E, Riggs BL, Kleerekoper M. Measurement of vertebral area on spine X-rays in osteoporosis: reliability of digitizing techniques. J Bone Miner Res 1990;5:707–16.
Storm T, Thamsborg G, Stemiche T, Genant HK, Sorensen OH. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med 1990;322:1265–71.
Genant HK. Vertebral fracture assessment using semiquantitative and quantitative techniques. J Bone Miner Res 1991;6:S274.
Genant HK, Wu CY, Van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993;8:1137–48.
Genant HK. Radiographic assessment of the effects of intermittent cyclical treatment with etidronate. In: Christiansen C, Overgaard K, editors. Osteoporosis 1990. Denmark: Aalborg, 2047–54.
Sorensen OH, Storm T, Thamsborg G, Sorensen HA, Kollerup G, Steinische T, Melsen F, Genant HK. Bisphosphonates and osteoporosis. Osteoporosis Int 1993;3(Suppl 1):S223–5.
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Leidig-Bruckner, G., Genant, H.K., Minne, H.W. et al. Comparison of a semiquantitative and a quantitative method for assessing vertebral fractures in osteoporosis. Osteoporosis Int 4, 154–161 (1994). https://doi.org/10.1007/BF01623062
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DOI: https://doi.org/10.1007/BF01623062