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The Accuracy of Incident Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research Ma, J., Siminoski, K., Wang, P., Jaremko, J. L., Koujok, K., Matzinger, M. A., Shenouda, N., Lentle, B., Alos, N., Cummings, E. A., Ho, J., Houghton, K., Miettunen, P. M., Scuccimarri, R., Rauch, F., Ward, L. M., Canadian STOPP Consortium, Ward, L. M., Konji, V., Scharke, M., Sykes, E., Ho, J., Kloiber, R., Lewis, V., Midgley, J., Miettunen, P., Stephure, D., Lentle, B. C., Blydt-Hansen, T., Cabral, D., Dix, D. B., Houghton, K., Nadel, H. R., Hay, J., Feber, J., Halton, J., Jurencak, R., Koujok, K., Matzinger, M., Roth, J., Shenouda, N., Watanabe-Duffy, K., Cairney, E., Clarson, C., Filler, G., Grimmer, J., McKillop, S., Sparrow, K., Stein, R., Cummings, E., Fernandez, C., Huber, A. M., Lang, B., O'Brien, K., Arora, S., Atkinson, S., Barr, R., Coblentz, C., Dent, P. B., Larche, M., Ma, J., Abish, S., Bell, L., LeBlanc, C., Sbrocchi, A. M., Scuccimarri, R., Moher, D., Taljaard, M., Rauch, F., Alos, N., Dubois, J., Laverdiere, C., Phan, V., Saint-Cyr, C., Barsalou, J., Couch, R., Ellsworth, J., Jaremko, J., Siminoski, K., Wilson, B., Grant, R., Charron, M., Hebert, D., Gaboury, I., Taback, S., Israels, S., Oen, K., Pinsk, M., Reed, M., Rodd, C. 2021

Abstract

Vertebral fractures are clinically important sequelae of a wide array of pediatric diseases. In this study we examined the accuracy of case-finding strategies for detecting incident vertebral fractures (IVF) over two years in glucocorticoid-treated children (n=343) with leukemia, rheumatic disorders, or nephrotic syndrome. Two clinical situations were addressed: the prevalent vertebral fracture (PVF) scenario (when baseline PVF status was known), which assessed the utility of PVF and low lumbar spine bone mineral density (LS BMD; Z-score<-1.4), and the Non-PVF scenario (when PVF status was unknown), which evaluated low LS BMD and back pain. LS BMD was measured by dual-energy x-ray absorptiometry, vertebral fractures were quantified on spine radiographs using the modified Genant semi-quantitative method, and back pain was assessed by patient report. Forty-four patients (12.8%) had IVF. In the PVF scenario, both low LS BMD and PVF were significant predictors of IVF. Using PVF to determine which patients should have radiographs, 11% would undergo radiography (95% CI, 8, 15) with 46% of IVF (95% CI, 30, 61) detected. Sensitivity would be higher with a strategy of PVF or low LS BMD at baseline (73%; 95% CI, 57, 85), but would require radiographs in 37% of children (95% CI, 32, 42). In the Non-PVF scenario, the strategy of low LS BMD and back pain produced the highest specificity of any non-PVF model at 87% (95% CI, 83, 91), the greatest overall accuracy at 82% (95% CI, 78, 86), and the lowest radiography rate at 17% (95% CI, 14, 22). Low LS BMD or back pain in the non-PVF scenario produced the highest sensitivity at 82% (95% CI, 67, 92), but required radiographs in 65% (95% CI, 60, 70). These results provide guidance for targeting spine radiography in children at risk for IVF.

View details for DOI 10.1002/jbmr.4294

View details for PubMedID 33784410