To detect painful vertebral fractures (VFs) in back pain populations at risk of osteoporosis, we designed a physical examination test (the Back Pain-Inducing Test [BPIT]) that included three movements: lying supine, rolling over, and sitting up. If back pain is induced during any of these movements, the result is defined as positive, thereby establishing a presumptive diagnosis of painful VFs. Pain severity is quantified using a self-reported numerical rating scale (NRS). The presence or absence of painful VFs is verified by whole-spine magnetic resonance imaging (MRI), the gold standard for final diagnosis. According to the standards for reporting diagnostic accuracy, a real-world, prospective, and observational study was performed on 510 back pain patients (enrolled from a single institute) at risk of osteoporosis. The sensitivity, specificity, and accuracy of the BPIT for identifying painful VFs were 99.1% (95% CI, 97.5% to 99.8%), 67.9% (95% CI, 60.4% to 74.5%), and 89.0%, respectively. The positive and negative predictive values were 86.6% (95% CI, 82.9% to 89.6%) and 97.4% (95% CI, 92.6% to 99.3%), respectively. Cutoff NRS scores for lying supine, rolling over, and sitting up were 3, 0, and 2, respectively. The corresponding area under the receiver operating characteristic curves (AUROCs) of each movement was 0.898 (95% CI, 0.868 to 0.922), 0.884 (95% CI, 0.854 to 0.911), and 0.910 (95% CI, 0.882 to 0.933), respectively. Although the high prevalence of VFs in the enrolled cohort partially limits the external validity of the predictive value in the general population, we conclude that the BPIT is potentially effective for detecting painful VFs in back pain populations at risk of osteoporosis. This test may be used as a stratification tool in decision-making on subsequent imaging procedures: a negative BPIT rules out painful VFs and indicates that an MRI should be spared, whereas a positive BPIT means that an MRI is necessary and is likely to identify painful VFs. © 2019 American Society for Bone and Mineral Research.

中文翻译：

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腰痛诱导试验，一种针对疼痛性骨质疏松性椎骨骨折的新颖且敏感的筛查试验：一项前瞻性临床研究。

为了检测处于骨质疏松症风险的背痛人群的椎骨骨折（VFs），我们设计了一项体格检查测试（背痛诱发测试[BPIT]），该测试包括三个动作：仰卧，翻身和坐立。如果在这些运动中的任何一个运动过程中引起了背痛，则将结果定义为阳性，从而建立对疼痛性室颤的推定诊断。疼痛严重程度使用自我报告的数字评分量表（NRS）进行量化。通过最终诊断的金标准全脊柱磁共振成像（MRI）验证是否存在疼痛性室颤。根据报告诊断准确性的标准，对510名有骨质疏松症风险的背痛患者（从一家机构入学）进行了真实，前瞻性和观察性研究。敏感性，特异性，BPIT识别疼痛性VF的准确度和准确性分别为99.1％（95％CI，97.5％至99.8％），67.9％（95％CI，60.4％至74.5％）和89.0％。阳性和阴性预测值分别为86.6％（95％CI，82.9％至89.6％）和97.4％（95％CI，92.6％至99.3％）。仰卧，翻身和仰卧起坐的临界NRS得分分别为3、0和2。每个动作的接收器工作特性曲线（AUROC）下的相应面积分别为0.898（95％CI，0.868至0.922），0.884（95％CI，0.854至0.911）和0.910（95％CI，0.882至0.933），分别。尽管已入组队列中VF的高患病率部分限制了一般人群中预测值的外部有效性，我们得出的结论是，BPIT对检测骨质疏松症风险的背痛人群中的疼痛性VF可能是有效的。该测试可用作后续成像程序决策中的分层工具：BPIT阴性可排除痛苦的室颤，并表示应避免进行MRI检查，而BPIT阳性则意味着必须进行MRI检查并可能识别出疼痛VFs。©2019美国骨骼和矿物质研究学会。