Identification of Vertebral Fracture and Non-Osteoporotic Short Vertebral Height in Men: The MrOS Study

Abstract

Non-osteoporotic SVH may mimic VF but is excluded in ABQ. In men, this led to discordance between ABQ and other methods, but SVH was not linked to low bone density. Exclusion of SVH could reduce false positives.Introduction: Non-osteoporotic short vertebral height (SVH) may mimic vertebral fracture (VF). The aims were to (1) compare the prevalence of VF in elderly men using the algorithm-based qualitative (ABQ), semiquantitative (SQ), and triage-quantitative morphometric (triage-QM) methods; (2) identify reasons for discordance between methods; and (3) determine whether SVH identified by ABQ is linked to low BMD. Materials and Methods:We studied a subset of 732 men ages Ն65 yr participating in the Osteoporotic Fractures in Men (MrOS) Study. Criteria for VF were (1) ABQ: endplate depression; (2) SQ: estimated vertebral height reduction Ն20%; (3) triage-QM: vertebral height ratio >3 SD below the reference mean, on radiographs showing evidence of VF. Criteria for SVH (ABQ) were apparent "reduction" in vertebral height Ն ∼15%, without evidence of endplate depression. Results:The prevalence of at least one VF was 10% (ABQ); 13% (SQ) and 11% (QM-triage) and of at least one SVH (ABQ) was >50%. Agreement between methods was moderate ( ‫ס‬ 0.42-0.62). Discordance between methods related mainly to classification of mild thoracic wedging or possible traumatic VF by ABQ. Mean BMD was lower in men with VF (any diagnostic method) than in those without (two-sample t-test, p < 0.05). For ABQ, BMD was similar in men with SVH (no VF) and men with normal vertebrae (ANOVA, p > 0.05). Mean BMD was significantly lower than expected in 40 men with VF identified by all three methods and average or more than average in those identified by a single method. Conclusions: Among elderly men (1) the prevalence of VF ranges from 10% to 13%: (2) agreement between diagnostic methods is moderate: discordance relates mainly to differential classification of mild thoracic deformities or ABQ definition of VF as traumatic; and (3) SVH identified by ABQ is common and not linked to low BMD.

Association between incident and baseline vertebral fractures in European women: vertebral fracture assessment in the Osteoporosis and Ultrasound Study (OPUS)

“…The ABQ method generally identifies fewer prevalent fractures than other approaches [8,11] which might explain the lower prevalence in this compared to other recent VFA studies [12][13][14][15][16]. We could have failed to detect some fractures due to poor differentiation of the vertebral endplates on VFA, but the relatively low prevalence identified by ABQ may also reflect differences in the criteria used to define fracture.…”

High prevalence of vertebral fractures despite normal bone mineral density in patients with long-term controlled acromegaly

“…The prevalence of VFs in acromegalic patients largely exceeded the prevalence in the control population, in all age groups (25). In addition, large European population-based cohort studies also report a much lower prevalence of VFs in both men and women (28)(29)(30)(31)(32), comparable to the findings in the Dutch reference cohort. Our findings, based on the scoring of two independent scorers and confirmed by an experienced radiologist, demonstrate that the prevalence of VFs in acromegalic women, but even more so in acromegalic men, exceeds the reported prevalence of VFs in the general population, including the Dutch population.…”

Serum uric acid is associated with bone health in older men: A cross-sectional population-based study

“…Moreover, it is recognized increasingly that osteoporosis is an important but understudied health problem in men. (62,63) In conclusion, this large population-based study demonstrates that in older men, serum UA levels are strongly associated with BMD and indices of calcium homeostasis and bone resorption. Higher serum UA levels are associated with a lower prevalence of osteoporosis and minimal-trauma vertebral and nonvertebral fractures.…”