A clinical tool to identify older women with back pain at high risk of osteoporotic vertebral fractures (Vfrac): a population-based cohort study with exploratory economic evaluation.
Age Ageing
; 51(3)2022 03 01.
Article
em En
| MEDLINE
| ID: mdl-35284926
ABSTRACT
BACKGROUND:
osteoporotic vertebral fractures (OVFs) identify people at high risk of future fractures, but despite this, less than a third come to clinical attention. The objective of this study was to develop a clinical tool to aid health care professionals decide which older women with back pain should have a spinal radiograph.METHODS:
a population-based cohort of 1,635 women aged 65+ years with self-reported back pain in the previous 4 months were recruited from primary care. Exposure data were collected through self-completion questionnaires and physical examination, including descriptions of back pain and traditional risk factors for osteoporosis. Outcome was the presence/absence of OVFs on spinal radiographs. Logistic regression models identified independent predictors of OVFs, with the area under the (receiver operating) curve calculated for the final model, and a cut-point was identified.RESULTS:
mean age was 73.9 years and 209 (12.8%) had OVFs. The final Vfrac model comprised 15 predictors of OVF, with an AUC of 0.802 (95% CI 0.764-0.840). Sensitivity was 72.4% and specificity was 72.9%. Vfrac identified 93% of those with more than one OVF and two-thirds of those with one OVF. Performance was enhanced by inclusion of self-reported back pain descriptors, removal of which reduced AUC to 0.742 (95% CI 0.696-0.788) and sensitivity to 66.5%. Health economic modelling to support a future trial was favourable.CONCLUSIONS:
the Vfrac clinical tool appears to be valid and is improved by the addition of self-reported back pain symptoms. The tool now requires testing to establish real-world clinical and cost-effectiveness.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Fraturas da Coluna Vertebral
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Fraturas por Osteoporose
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Health_economic_evaluation
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
Idioma:
En
Revista:
Age Ageing
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Reino Unido