The accuracy of prevalent vertebral fracture detection in children using targeted case‐finding approaches

Ma, Jinhui; Siminoski, Kerry; Wang, Peiyao; Alos, Nathalie; Cummings, Elizabeth A.; Feber, Janusz; Halton, Jacqueline; Ho, Josephine; Houghton, Kristin; Lang, Bianca; Miettunen, Paivi M.; Scuccimarri, Rosie; Jaremko, Jacob L.; Koujok, Khaldoun; Lentle, Brian; Matzinger, Mary Ann; Shenouda, Nazih; Rauch, Frank; Ward, Leanne M.

Affiliations

¹Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

²Department of Radiology and Diagnostic Imaging and Department of Internal Medicine, University of Alberta, Edmonton, AB, Canada

³Faculty of Science, McMaster University, Hamilton, ON, Canada

⁴Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada

⁵Department of Pediatrics, Dalhousie University, Halifax, NS, Canada

⁶Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada

⁷Department of Pediatrics, University of Calgary, Calgary, AB, Canada

⁸Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

⁹Department of Pediatrics, McGill University, Montreal, QC, Canada

¹⁰Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada

¹¹Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada

¹²Department of Radiology, University of British Columbia, Vancouver, BC, Canada

¹³Canadian Pediatric Bone Health Working Group, Ottawa, ON, Canada

Abstract and keywords

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 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.

Keywords: CHILDREN; FRACTURE IDENTIFICATION; SENSITIVITY; SPECIFICITY; VERTEBRAL FRACTURE

Links

DOI: 10.1002/jbmr.3922

PubMed: 31742768

WoS: 000502939900001

History

Received: 2019-06-28

Revised: 2019-11-07

Accepted: 2019-11-11

Online: 2019-11-18

Cited By (1)

Year	Entry
2021	Ma J, Siminoski K, Wang P, Jaremko JL, Koujok K, Matzinger MA, Shenouda N, Lentle B, Alos N, Cummings EA, Ho J, Houghton K, Miettunen PM, Scuccimarri R, Rauch F, Ward LM; Canadian STOPP Consortium. The accuracy of incident vertebral fracture detection in children using targeted case-finding approaches. J Bone Miner Res. July 2021;36(7):1255-1268.