Score of Roux et al for Predicting a Vertebral Fracture in a Postmenopausal Woman with Osteoporosis and Back Pain

Patient selection: postmenopausal woman with osteoporosis and back pain

Parameters:

(1) age

(2) intensity of the back pain (on a 10 cm visual analogue scale, VAS)

(3) loss of height in centimeters

(4) history of non-vertebral fractures (pelvis, forearm, rib, hip)after low-impact trauma

(5) sudden onset of pain

(6) pain localized to thoracic spine

total score =

= SUM(points for all 6 parameters)

Interpretation:

• minimum score: 0

• maximum score: 16

• The higher the score the greater the chance of a vertebral fracture.

• A score >= 7 is associated with a vertebral fracture in 43% of patients.

• A score <= 2 is associated with a vertebral fracture in < 20% of patients.

Performance:

• The area under to ROC curve is 0.77.

• The positive predictive value is 71% and the negative predictive value is 69%.

Alternatively a logistic regression formula can be used (see pages 83-84):

X =

= (0.0734 * (age in years)) + (0.6129 if pain >= 6.5 cm on VAS) + (0.6622 if height loss 3 to 5.99 cm) + (1.1723 if height loss >= 6 cm) + (0.4793 if history of low impact fractures) + (0.4852 with thoracic localization of pain) + (1.2146 for suddon pain onset) - 7.1082

probability of an osteoporotic vertebral fracture =

= 1 / (1 + EXP((-1) * X))