ORIGINAL ARTICLE Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures K. Siminoski Æ G. Jiang Æ J.D. Adachi Æ D.A. Hanley G. Cline Æ G. Ioannidis Æ A. Hodsman Æ R.G. Josse D. Kendler Æ W.P. Olszynski Æ L.-G. Ste. Marie R. Eastell Received: 24 September 2003 / Accepted: 18 June 2004 / Published online: 11 August 2004 Ó International Osteoporosis Foundation and National Osteoporosis Foundation 2004 Abstract Vertebral fractures are the most common type of osteoporotic fracture, but more than two-thirds re- main undetected. We have examined the relationship between height loss and the development of new verte- bral fractures to determine whether there is a height loss threshold that has useful clinical accuracy to detect new fractures. We studied 985 postmenopausal women with osteoporosis in the placebo arms of the Vertebral Effi- cacy with Risedronate Therapy studies. Height was measured annually for 3 years using a wall-mounted stadiometer. New fractures were determined using quantitative and semi-quantitative radiographic mor- phometry. The relationship between height loss over three years and the number of new vertebral fractures was: height loss (cm)=0.95·number of new vertebral fractures)0.4 cm (r=0.33). The odds ratio for the development of a new fracture increased up to 20.6 (95% confidence interval, 9.3, 45.8) when height loss was greater than 4.0 cm. At a threshold of >2.0 cm height loss over 3 years, sensitivity was 35.5% for detecting new vertebral fractures and specificity was 93.6%. These findings show that there is a strong relationship between the amount of height loss and the risk of a new vertebral fracture. While there is no cut-off that can reliably rule in a new fracture, height loss of £ 2.0 cm over 1–3 years has acceptable accuracy for ruling out an incident frac- ture. Keywords Height loss Æ Osteoporosis Æ Postmenopausal women Æ Stature Æ Vertebral fracture Introduction Vertebral fractures are a well-recognized consequence of postmenopausal osteoporosis and are the most common type of osteoporotic fracture [1]. Less than one-third of Osteoporos Int (2005) 16: 403–410 DOI 10.1007/s00198-004-1709-z K. Siminoski Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Alberta, Edmonton, Canada G. Jiang Æ R. Eastell Bone Metabolism Group, Section of Medicine, Division of Clinical Sciences (North), University of Sheffield, Sheffield, UK J.D. Adachi Department of Medicine, St Joseph’s Hospital, McMaster University, Hamilton, Canada D.A. Hanley Department of Medicine, Foothills Hospital, University of Calgary, Calgary, Canada G. Cline Procter & Gamble Pharmaceuticals, Mason, USA G. Ioannidis Charlton Medical Centre, Hamilton, Canada A. Hodsman Department of Medicine, University of Western Ontario, London, Canada R.G. Josse Department of Medicine, University of Toronto, Toronto, Canada D. Kendler Department of Medicine, University of British Columbia, Vancouver, Canada W. P. Olszynski Department of Medicine, University of Saskatchewan, Saskatoon, Canada L.-G. Ste. Olszynski Department of Medicine, University of Montreal, Montreal, Canada K. Siminoski (&) 362 HMRC, University of Alberta, Edmonton, ABT6G 2S2, Canada E-mail: kerrygs@telusplanet.net Tel.: +1-780-4078414 Fax: +1-780-4076702