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J Clin Densitom. 2014 Jul-Sep;17(3):378-85. doi: 10.1016/j.jocd.2013.09.021. Epub 2014 Feb 25.

Prediction models of prevalent radiographic vertebral fractures among older women.

Author information

  • 1Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA. Electronic address:
  • 2Beth Israel Deaconess Medical Center, Boston, MA, USA.
  • 3Department of Medicine, University of Chicago, Chicago, IL, USA.
  • 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
  • 5San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, CA, USA.
  • 6Division of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.
  • 7Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA.
  • 8Departments of Family and Preventive Medicine and Internal Medicine, University of California at San Diego, San Diego, CA, USA.
  • 9Division of Epidemiology, University of Minnesota, Minneapolis, MN, USA and Minneapolis Veterans Administration Medical Center, Minneapolis, MN, USA.


It is unknown how well prediction models incorporating multiple risk factors identify women with radiographic prevalent vertebral fracture (PVFx) compared with simpler models and what their value might be in clinical practice to select older women for lateral spine imaging. We compared 4 regression models for predicting PVFx in women aged 68 y and older enrolled in the Study of Osteoporotic Fractures with a femoral neck T-score ≤ -1.0, using area under receiving operator characteristic curves (AUROC) and a net reclassification index. The AUROC for a model with age, femoral neck bone mineral density, historical height loss (HHL), prior nonspine fracture, body mass index, back pain, and grip strength was only minimally better than that of a more parsimonious model with age, femoral neck bone mineral density, and historical height loss (AUROC 0.689 vs 0.679, p values for difference in 5 bootstrapped samples <0.001-0.35). The prevalence of PVFx among this older population of Caucasian women remained more than 20% even when women with low probability of PVFx, as estimated by the prediction models, were included in the screened population. These results suggest that lateral spine imaging is appropriate to consider for all Caucasian women aged 70 y and older with low bone mass to identify those with PVFx.

Copyright © 2014 The International Society for Clinical Densitometry. All rights reserved.


Bone densitometry; model discrimination; prediction models; prevalent vertebral fracture; vertebral fracture assessment

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[Available on 2015-07-01]
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