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In this study, we examined the accuracy of case-finding strategies for detecting incident vertebral fractures (IVF) over 2\u2009years in glucocorticoid-treated children (n\u00a0=\u00a0343) with leukemia, rheumatic disorders, or nephrotic syndrome. Two clinical situations were addressed: the prevalent vertebral fracture (PVF) scenario (when baseline PVF status was known), which assessed the utility of PVF and low lumbar spine bone mineral density (LS BMD; Z-score &amp;lt;\u22121.4), and the non-PVF scenario (when PVF status was unknown), which evaluated low LS BMD and back pain. LS BMD was measured by dual-energy X-ray absorptiometry, vertebral fractures were quantified on spine radiographs using the modified Genant semiquantitative method, and back pain was assessed by patient report. Forty-four patients (12.8%) had IVF. In the PVF scenario, both low LS BMD and PVF were significant predictors of IVF. Using PVF to determine which patients should have radiographs, 11% would undergo radiography (95% confidence interval [CI] 8\u201315) with 46% of IVF (95% CI 30\u201361) detected. Sensitivity would be higher with a strategy of PVF or low LS BMD at baseline (73%; 95% CI 57\u201385) but would require radiographs in 37% of children (95% CI 32\u201342). In the non-PVF scenario, the strategy of low LS BMD and back pain produced the highest specificity of any non-PVF model at 87% (95% CI 83\u201391), the greatest overall accuracy at 82% (95% CI 78\u201386), and the lowest radiography rate at 17% (95% CI 14\u201322). Low LS BMD or back pain in the non-PVF scenario produced the highest sensitivity at 82% (95% CI 67\u201392), but required radiographs in 65% (95% CI 60\u201370). These results provide guidance for targeting spine radiography in children at risk for IVF. \u00a9 2021 American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4294","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T12:33:06Z","timestamp":1617107586000},"page":"1255-1268","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Accuracy of Incident Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches"],"prefix":"10.1093","volume":"36","author":[{"given":"Jinhui","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Siminoski","sequence":"additional","affiliation":[{"name":"Department of Radiology and Diagnostic Imaging and Department of Internal 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