Presence of positive closed-fist percussion sign, supine sign, or back pain inducing test are suggested as findings on physical exam useful in identifying an adult patient with symptomatic acute osteoporotic vertebral compression fractures. Grade of Recommendation: B

In a prospective observational study, Jin et al1 aimed to determine the diagnostic value of the back-pain inducing test (BPIT), which is used as a means to detect painful osteoporotic vertebral fractures in populations at risk of osteoporosis. The authors concluded that “the BPIT is a potentially effective screening test to detect painful VFs in the back pain population at risk of osteoporosis, although the high prevalence of VFs in the present study partially limited the external validity of the BPIT’s predictive value in the general population.” The work group downgraded this potential Level I paper due to nonconsecutive patients, nonmasked reviewers, and high prevalence of VCFs in the population. This paper provides Level II evidence that the BPIT is a potentially effective screening test to detect painful VFs in patients with back pain with a high sensitivity and specificity. In a prospective observational study, Langdon et al2 assessed how effective two clinical signs, closed fist percussion and supine signs, are in predicting a systematic OVCF. The authors concluded that “these two clinical signs are useful adjuncts in the diagnostic evaluation of symptomatic osteoporotic VCF, as either a positive closed-fist percussion sign or a positive supine sign is a reliable indicator of the presence of a symptomatic vertebral compression fracture.” The work group downgraded this potential Level I paper due to selection bias and nonmasked reviewers. This paper provides Level II evidence that positive closed-fist percussion sign and supine sign are sensitive and specific indicators of the presence of a symptomatic VCF. References 1. Jin H, Ma X, Liu Y, et al. Back Pain-Inducing Test, a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study. J Bone Miner Res. 2020;35(3):488-497. doi:10.1002/jbmr.3912 2. Langdon J, Way A, Heaton S, Bernard J, Molloy S. Vertebral compression fractures--new clinical signs to aid diagnosis. Ann R Coll Surg Engl. 2010;92(2):163-166. doi:10.1308/003588410X12518836440162

There is insufficient evidence to make a recommendation for or against a patient self-assessment screening tool to identify individuals at risk for acute osteoporotic vertebral compression fractures. Grade of Recommendation: I

In a prospective observational study, Yang et al1 aimed to validate the effectiveness of the Osteoporosis Self-assessment Tool for Asians (OSTA) to identify the increased risk of primary osteoporosis and painful new osteoporotic vertebral fractures in postmenopausal women from a selected Han Chinese population in Beijing. The authors concluded that “the OSTA may be a simple and effective tool for identifying the risk of osteoporosis and new painful osteoporotic vertebral fractures in Han Chinese women.” This paper provides Level III evidence that in the Han Chinese population, the OSTA index may be a useful test to identify individuals at risk for acute painful VCF.

References 1. Yang Y, Wang B, Fei Q, et al. Validation of an osteoporosis self-assessment tool to identify primary osteoporosis and new osteoporotic vertebral fractures in postmenopausal Chinese women in Beijing. BMC Musculoskelet Disord. 2013;14:271. doi:10.1186/1471-2474-14-271