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. (14th March 2022)

• Record Type: Journal Article
• Authors: Khera, Tarnjit; Hunt, Linda P; Davis, Sarah; Gooberman-Hill, Rachael; Thom, Howard; Xu, Yixin; Paskins, Zoe; Peters, Tim J; Tobias, Jon H; Clark, Emma M
• Is Part Of: Age and ageing. Volume 51:Number 3(2022)
• Publication Date: 2022-03-14
• Subjects: vertebral fractures -- back pain -- Osteoporosis -- Vfrac -- cohort study -- older people; Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afac031
• Languages: English
• ISSNs: 0002-0729

Abstract

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.