Maria Fusaro 1, M. D. , Ph. D. , Giovanni Tripepi2, M. S. C

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1 A NEW QUALITATIVE SCORE TO EVALUATE VERTEBRAL FRACTURES FROM THE EVERFRACT STUDY
Maria Fusaro 1, M.D., Ph.D., Giovanni Tripepi2, M.S.C ., Marianna Noale 1, M.S.C., Angela D’Angelo3, M.D., Nicola Vajente4, Davide Miozzo3,M.D., and Maurizio Gallieni5, M.D., p 1CNR Aging Section, Institute of Neuroscience, Padua, Italy;2CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases Hypertension of Reggio Calabria,Reggio Calabria , Italy; 3 Nephrology Unit, University of Padua, Italy; 4Medicina di Laboratorio, University-Hospital of Padua,Italy; 5Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Milan, Italy INTRODUCTION and AIMS METHODS Vertebral fracture (VF) is a reduction by >20% of the vertebral body height. Quantitative vertebral morphometry (QVM) identifies VF by measurements of the T5 to L4 vertebral bodies in a latero-lateral X-ray of the spine. Severity of fractures is estimated as mild, moderate or severe depending on the reduction of height (20-25%, 25-40% or >40% respectively). Types of deformity depend on the anterior, central or posterior vertebral height (wedge, biconcave or crush fractures, respectively). (Fig. 1) Aim: We compared Spine Deformity Index (SDI) understood as the arithmetic sum of all vertebral deformation with SDI understood as the arithmetic average of all vertebral deformation. In 387 hemodialysis (HD) patients (F, 37%; M 63%, mean age 64±14 years, median dialytic age 49 months, BMI 25±4 Kg/m2) from 18 dialysis centers, we evaluated VF with a computerized analysis (MorphoXpress) of L-L vertebral X-rays. We compared the traditional Spine Deformity Index (SDI: arithmetic sum of all vertebral deformation between T5 and L4 – Sauer Score, JBMR 1991;6;227) with a modified SDI (arithmetic average of all vertebral deformation – Fusaro Score) (Table 1). RESULTS We found that 55% of patients had VF. Dorsal and wedge VF were predominant. Males had more VF than females (60% versus 48%, p=0.019) (Fig. 2). Lumbar VF were less common, but more severe. The latter finding was better shown by the Fusaro Score (qualitative evaluation), as the Sauer Score gives a quantitative evaluation (Table 1). Fig.1 Types of vertebral fractures Vertebra Mild Moderate VF (n) Severe VF (n) Sauer Score Fusaro Score T5 24 7 38 1,23 T6 33 14 1 64 1,33 T7 12 62 1,24 T8 35 10 55 1,22 T9 26 8 45 1,29 T10 19 1,30 T11 30 3 67 1,43 T12 17 2 75 1,39 L1 49 1,48 L2 4 16 1,78 L3 1,60 L4 13 21 Total 278 112 11 535 [Sum] 1,38 [Average] Table 1. Comparison of Sauer and Fusaro Scores Fig. 2. VF and gender CONCLUSIONS In dialysis patients, prevalence of VF assessed with QVM is markedly higher than previously reported. We defined a qualitative SDI score for diagnosis and monitoring of patients with VF. Participating centers: Adria (Dott. Stoppa F; Dott.ssa Bernardi AM); Bassano del Grappa (Dott.ssa Pellanda V; Dott. Dell’Aquila R); Belluno (Dott. Tarroni G; Dott. De Paoli Vitali); Bolzano (Dott. Corradini R; Dott. Avolio M; Dott.Giacon B); Castelfranco V.to (Dott. Ferraro A; Dott. De Luca M); Dolo (Dott. Lucatello S; Dott.ssa Meneghel G); Feltre (Dott. Vianello A; Dott. Antonucci F); Firenze (Dott.ssa Grimaldi C; Dott. Mannarino A); Lodi (Dott. Barbisoni F; Dott. Elli A); Mestre (Dott. Morachiello P; Dott. Feriani M); Padova (Dott.ssa Rebeshini M; Dott. Naso A); Piove di Sacco-Chioggia (Dott.ssa Spinello M; Dott. Urso M); Rovigo (Dott.ssa Pati T; Dott. Gemelli A; Dott.ssa Bernardi AM); Schio (Dott.ssa Magonara FM; Dott. Axia M); Sesto SG (Dott. Ciurlino D; Dott. Bertoli S); Trento (Dott. Pica A; Dott.ssa Venturelli C; Dott. Brunori G); Treviso (Dott.ssa Puggia R; Dott.ssa Caberlotto A; Dott.ssa Mastrosimone S; Dott. Cascone C); Voghera (Dott.ssa Foschi A; Dott Milanesi F) REFERENCES: 1.Genant HK, Wu CY, Van Kuijk C et al. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 1993; 8: 1137–1148 2. Witterman JC, Grobbee DE, Valkenburg HA et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet 343: , 1994. 3. Sauer P, Leidig G, Minne HW et al. Spine deformity index (SDI) versus other objective procedures of vertebral fracture identification in patients with osteoporosis: a comparative study.J Bone Miner Res 1991 Mar;6(3): Corresponding Author Maria Fusaro, M.D., Ph.D. CNR Aging Section, Institute of Neuroscience, Padua, Italy Via Giustiniani, 2, Padova, Italy. Telephone: FAX: