We undertook to evaluate the efficacy of C-reactive protein (CRP) determination as a screening test for the detection of malig-nancy in compression fracture patients by comparing simple compression fractures and malignant metastatic compression fractures of spine.

From January 1998 to March 2001, fifty-one patients who had compression fracture of spine with chronic back pain were analysed for CRP levels. The thirty-six patients had simple compression fractures of the spine and fifteen patients malignant metastatic compression fractures. The sensitivity, specificity and positive predictive value of CRP in the screening of benign simple compression fractures were calculated.

CRP levels in malignant metastatic compression fracture were significantly higher than in simple compression fracture. The sensitivity of CRP in simple compression fractures was 97%, its specificity 80% and its positive predictive value 92%.

We consider CRP titer to be a useful screening test for the detection of malignant metastatic compression fractures. In old age, a high titer of CRP needs more precise clinical definition for the detection of malignancy in compression fracture.