RESEARCH - A tool to determine the need for spine radiography in postmenopausal women with osteoporosis and back pain

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ls of the Rheumatic Diseases 2007;66:81-85

© 2007 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

A clinical tool to determine the necessity of spine radiography in

postmenopausal women with osteoporosis presenting with back pain

C Roux1, G Priol2, J Fechtenbaum1, B Cortet3, S Liu-Léage4 and M Audran5

1 Université Paris-Descartes, Hôpital Cochin, Paris, France

2 AREMIS, Paris, France

3 Service de Rhumatologie, CHU Lille, France

4 Laboratoire Lilly, Suresnes, France

5 Pôle ostéo-articulaire; EMI-INSERM 0335 CHU, Angers, France

Background: Vertebral fractures are underdiagnosed, although the resulting

mortality and morbidity in postmenopausal women with osteoporosis is now

recognised. In a population of postmenopausal women with osteoporosis and

back pain, symptoms may be related to vertebral fractures or degenerative

changes of the spine.

Aim: To evaluate a population of postmenopausal women presenting with back

pain and factors associated with vertebral fractures which were assessable

in a clinical setting in order to determine the necessity for spine

radiography.

Methods: Patient questioning and physical examination were carried out and

spinal radiographic data collected from 410 postmenopausal women with

osteoporosis, with an average age of 74 years, who consulted a

rheumatologist for back pain. Of these, 215 (52.4%) patients were diagnosed

with at least one vertebral fracture. Logistic regression was used to

identify the most relevant clinical features associated with existing

vertebral fractures, and to derive a quantitative index of risk.

Results: The model included six parameters: age, back pain intensity, height

loss, history of low trauma non-vertebral fractures, thoracic localisation

of back pain and sudden occurrence of back pain. The scoring system, or the

quantitative index, had a maximal score of 16. For a score 7, the

probability of existing vertebral fracture was 43%. The correlation between

this quantitative index and the logistic model probability was 0.98,

suggesting an excellent and highly significant approximation of the original

prediction equation.

Conclusions: : From six clinical items, an index was built to identify women

with osteoporosis and back pain who should have spine radiography. This

simple tool may help clinicians to optimise vertebral fracture diagnosis and

to make a proper therapeutic decision.

http://ard.bmj.com/cgi/content/abstract/66/1/81

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