Ferrar L et al. (2007) Identification of vertebral fracture and non-osteoporotic short vertebral height in men: the MrOS Study. J Bone Miner Res 22: 1434–1441

Osteoporotic vertebral fractures (VF) occur in both sexes, but few studies have investigated the condition in men. In spinal radiographs, VF and non-osteoporotic vertebral deformities can appear similar. The latter are more common in men, making differential diagnosis potentially more problematic.

Quantitative or semiquantitative methods are used to identify short vertebral height; however, these cannot differentiate between height decline caused by osteoporotic VF and developmentally short vertebrae, normal variants, degenerative modeling or long-standing reduced height related to an earlier traumatic event. Ferrar et al. compared the differential diagnostic ability of a semiquantitative method, a triage-quantitative morphometric method and an algorithm-based qualitative assessment (ABQ) in 732 men aged >65 years. ABQ primarily identifies osteoporotic vertebral fracture at the baseline examination when there is evidence of central endplate depression, with no minimum threshold for reduction in vertebral height.

The ABQ method identified VF in 10% of the men, compared with 13% and 11% for the semiquantitative and the triage-quantitative morphometric methods, respectively. Much of the discordance between methods occurred because the ABQ method classified some cases of VF identified by the other two methods as mild thoracic wedging or possible traumatic VF. The accuracy of the ABQ method was confirmed by measurements of mean bone mineral density. Densities were significantly lower in men diagnosed by ABQ as having true osteoporotic VF than in men with other spinal deformities.

The authors conclude that the ABQ method could be used in men to accurately diagnose true vertebral fractures related to osteoporosis.