Clinical predictors of vertebral osteoporotic fractures in post-menopausal women: a cross-sectional analysis

Eur Rev Med Pharmacol Sci 2012; 16 (9): 1227-1234
L.A. Nasto, A. Fusco*, D. Colangelo, M. Mormando*, G. Di Giacomo, B. Rossi, L. De Marinis*, C.A. Logroscino, E. Pola
Division of Spine Surgery, Department of Orthopaedic Surgery and Traumatology, *Division of Endocrinology, Department of Internal Medicine, School of Medicine, Catholic University of the Sacred Heart, “A. Gemelli” Hospital, Rome, Italy. luigiaurelionasto at yahoo.it
Orthopedics

BACKGROUND: Osteoporosis is a very common bone disorder and accounts for 1.4 million vertebral compression fractures (VCFs) per year, mostly in post-menopausal women.

AIM: The aim of this study was to develop a risk scoring system to identify and gauge the risk of osteoporotic VCFs in post-menopausal women.

Materials and Methods: We conducted a retrospective cross-sectional study on 477 post-menopausal women consecutively visited at our institution.
We studied 15 different clinical variables, i.e.

• age,
• body mass index (BMI),
• weight,
• L1-L4 lumbar T-Score,
• L1-L4 lumbar Z-Score,
• L1-L4 lumbar bone mineral density (BMD),
• femoral neck T-Score,
• femoral neck Z-Score,
• femoral neck BMD,
• smoking habit,
• alcohol consumption,
• 25-OH-vitamin D,
• total alkaline phosphatase,
• bone alkaline phosphatase, and
• L4 vertebral volume.

Study population was split in a derivation and a validation cohort. A logistic regression model was used to develop a predictive score of osteoporotic VCFs in the derivation cohort, finally the performance of the score was tested in the validation cohort.

RESULTS: Age, L1-L4 lumbar T-Score, femoral neck T-Score, L4 vertebral volume, and smoking habit were found to be predictors of VCFs.
To each variable a score from 0 to +12 was assigned to the magnitude of regression coefficient.
A score ? 22 identified VCFs with a sensitivity of 87%/89% and a specificity of 87%/90% in the derivation and validation cohorts, respectively.

CONCLUSIONS: Our findings indicate that a simple score derived from clinical history and routine diagnostic workout can be usefully employed to gauge the risk of fragility VCFs in post-menopausal women.

PMID: 23047507
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A great many other studies have found vitamin D to be important in reducing fractures

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