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 < -1.6) or back pain alone gave similar results for sensitivity (55%, 52%, respectively), specificity (78%, 81%, respectively), positive predictive value (PPV; 24%, 25%, respectively), and negative predictive value (NPV; 93%, 93%, respectively). The paradigm using low BMD 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. © 2019 American Society for Bone and Mineral Research.

中文翻译：

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使用针对性病例发现方法对儿童中普遍的椎骨骨折进行检测的准确性。

由于担心儿科患者的累积放射线暴露，在大多数容易导致椎体骨折（VF）的情况下进行脊柱X线照片不是标准做法。在这项研究中，我们检查了两种临床预测指标（背痛和腰椎骨矿物质密度（LS BMD））的准确性，以得出用于检测流行性VF（PVF）的四个案例发现范例。受试者为400名有PVF风险的儿童（白血病186，风湿病135，肾病综合症79）。通过患者报告评估背痛，通过双能X线吸收法测量LS BMD，并使用改良的Genant半定量方法在脊柱X线照片上对PVF进行定量。四十四名患者（11.0％）患有PVF。LS BMD和PVF之间的Logistic回归分析得出的比值比（OR）为1.9（95％置信区间[CI]，1。Z得分单位每减少5到2.5），接收器工作特性曲线下的面积为0.70（95％CI，0.60到0.79），最佳BMD Z得分截止值为-1.6。单独使用低BMD（Z评分<-1.6）或仅使用背痛进行病例鉴定，其敏感性（分别为55％，52％），特异性（分别为78％，81％），阳性预测值（PPV）的结果相似；分别为24％，25％）和阴性预测值（NPV；分别为93％，93％）。使用低BMD加背部疼痛的范例产生的敏感性较低（32％），特异性较高（96％），PPV较高（47％）和相似的NPV（92％）。使用低BMD或背部疼痛的方法具有最高的敏感性（75％），最低的特异性（64％），最低的PPV（20％）和最高的NPV（95％）。对于更高的骨折等级，所有范例均提高了敏感性。我们的结果表明，BMD和背痛史可用于识别发生PVF风险最高的儿童，因此可以明智地使用X线照相。要应用的具体范式将取决于预期的PVF率和使用放射线照相术的临床方法。©2019美国骨骼和矿物质研究学会。