Accuracy of physical examination using the rib-pelvis distance for detection of lumbar vertebral fractures

Clinical vertebral fractures, which are usually detected when patients present with back pain, account for less than one third of all vertebral fractures (1–5); the rest are occult and go undetected during routine nonradiologic evaluations. However, both clinical and occult vertebral fractures are associated with important health consequences (4 –12), and one of the challenges in improving care for patients with osteoporosis is enhancing the detection of occult vertebral fractures, such as during the physical examination (12–16). A decrease in height or a marked accentuation of the dorsal kyphosis suggests the presence of vertebral fractures (13,16). Little is known about how to detect fractures in the lumbar spine on clinical examination, although the first four lumbar vertebras account for 40% of all vertebral fractures. Because the decreased height of a fractured lumbar vertebra reduces the distance between the inferior margin of the ribs and the anterior superior iliac crest of the pelvis (16 –21), we evaluated the accuracy of using the rib-pelvis distance for detecting lumbar vertebral fractures.