Influence of baseline deformity definition on subsequent vertebral fracture risk in postmenopausal women
Influence of baseline deformity definition on subsequent vertebral fracture risk in postmenopausal women
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DOI：
10.1007/s00198-006-0106-1
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发表时间：
2006-07-01
影响因子：
4
通讯作者：
Eastell, R.
中科院分区：
文献类型：
--
作者：
Melton, L. J., III;Wenger, D. E.;Eastell, R.
引言：识别脊椎骨折的方法仍然存在争议。方法：对512名绝经后妇女的年龄分层人群样本进行了长达12年（4455人-年）的连续X线片随访。结果如下：在本研究期间，112名女性发生新发椎骨骨折（任何椎骨高度较基线降低20%），年年龄校正（2000年美国白色>= 50岁女性）发生率为23/1000。根据使用的形态学定义，基线时椎体畸形的患病率范围为3%至90%。最近一种标准化椎体高度的方法与X线片的定性临床阅读最一致[kappa（kappa），0.53]。几乎所有不同的基线定义都预测了未来的椎骨骨折，但大多数预测能力都归因于严重的（例如，4 SD）畸形包括在更慷慨的（例如，3 SD）分类。尽管宽松的定义更敏感，限制性的定义更具体，但通过c指数（类似于ROC曲线下面积）评估，它们预测新椎体骨折的总体能力大致相当。结论：这一结果表明，形态测量学定义的选择取决于特定的应用，特别是取决于是否更重要的是最大限度地提高灵敏度或特异性。
Introduction: Approaches for recognizing vertebral fractures remain controversial. Methods: An age-stratified population sample of 512 postmenopausal women was followed with serial radiographs for up to 12 years (4455 person-years). Results: 112 women experienced a new vertebral fracture (20% reduction in any vertebral height from baseline) within this study period, for an annual age-adjusted (to US white women >= 50 years of age in 2000) incidence of 23 per 1000. Depending on the morphometric definition used, the prevalence of vertebral deformities at baseline ranged from 3 to 90%. A recent method to standardize vertebral heights produced the best agreement with a qualitative clinical reading of the films [kappa (kappa), 0.53]. Almost all of the different baseline definitions predicted future vertebral fractures, but most of the predictive power was attributable to the severe (e.g., 4 SD) deformities included within more generous (e.g., 3 SD) classifications. Whereas the generous definitions were more sensitive, and the restrictive ones more specific, their overall abilities to predict a new vertebral fracture were roughly comparable as evaluated by the c-index (analogous to the area under an ROC curve). Conclusions: This result suggests that the choice of a morphometry definition depends on the particular application and, in particular, on whether it is more important to maximize sensitivity or specificity.