Body segment lengths and arm span in healthy men and women and patients with vertebral fractures.
ABSTRACT We studied 112 healthy men and 261 healthy women aged 18-92 years, and 34 men and 73 postmenopausal women with vertebral fractures aged 45-90 years to determine (i) whether patients with vertebral fractures have shorter stature before fracture, and (ii) whether the difference between arm span and standing or sitting height can be used to identify patients with fractures. Arm span was measured by using a calibrated extended ruler. Standing height, sitting height and leg length were measured by using a Holtain stadiometer. The results were expressed in absolute term and standard deviation (SD) or Z-scores (mean+/-SEM). Advancing age was associated with decreased sitting height (r=-0.37 to -0.41, both P<0.01) and a trend towards decreased arm span (r=-0.12 to -0.17, P=0.06 and 0.07) in healthy men and women; leg length was independent of age in both sexes (r=-0.09 to -0.12, NS). In patients with vertebral fractures, sitting height was reduced in women (Z=-0.83+/-0.14 SD, P<0.01) and men (Z=-1.37+/-0.21 SD, P<0.01) but only the women had reduced leg length (Z=-0.46+/-0.15 SD, P<0.01) and arm span (Z=-0.76+/-0.15 SD, P<0.01). Univariate and multivariate analyses suggest that the predictive ability of the difference between arm span and standing or sitting height to identify patients with vertebral fractures is limited. We concluded that women, not men, with vertebral fractures may come from a population with short stature. The difference between arm span and standing or sitting height cannot be used to predict vertebral fracture risk.
Article: The accuracy of historical height loss for the detection of vertebral fractures in postmenopausal women.[show abstract] [hide abstract]
ABSTRACT: Historical height loss (HHL) can be calculated as the difference between a patient's tallest recalled height (TRH) and the current measured height (MH). We have examined the accuracy of HHL as a clinical test for the detection of prevalent vertebral fractures. Subjects were postmenopausal women aged 50 or older who had been referred for specialist assessment of osteoporosis risk (n=323; average age 66.0+/-9.2 years; range 50-92 years). MH was determined using a wall-mounted stadiometer. The presence of prevalent vertebral fractures was assessed by radiographic morphometry, with fracture defined as a vertebral height ratio<0.8. The positive likelihood ratio (LR+) for fracture was relatively flat until HHL>6.0 cm. With HHL from 6.1 to 8.0 cm, the LR+ was 2.8 [95% confidence interval (95%CI), 1.3, 6.0]. When HHL was >8.0 cm, the LR+ was 9.8 (95% CI, 3.0, 31.8). The area under the receiver operating characteristics curve for the ability of HHL to detect fracture was 0.66 (95% CI, 0.59, 0.72). At HHL>6.0 cm, sensitivity was 30% (95% CI, 22, 37%), and specificity was 94% (95% CI, 90, 97%). The positive predictive value was relatively low across a range of theoretical prevalence, rising above 80% only at very high prevalence rates (>50%). In contrast, the negative predictive value was high at the prevalence rates seen in most clinical practice, and dropped below 80% only when the prevalence exceeded 25%. This study shows that HHL<or=6.0 cm rules out prevalent vertebral fracture with a high degree of accuracy; patients with HHL>6.0 cm should have spine radiographs to examine for the presence of vertebral fractures.Osteoporosis International 03/2006; 17(2):290-6. · 4.58 Impact Factor