Krieg M A, Lamy O
Service de Médecine A, CHUV, Lausanne.
Praxis (Bern 1994). 2004 Feb 25;93(9):321-8. doi: 10.1024/0369-8394.93.9.321.
At the age of 50, a women has a lifetime risk of more than 30% to present a radiological vertebral fracture (vertebral deformity). Among the women of 50 to 79 years, 12 to 20% of them have one or more prevalent vertebral deformities. For Switzerland, it represents about 130,000 to 220,000 women. For men, the global prevalence of these fractures is the same. However, they usually happen in younger men who are exposed to greater trauma than women. The situation is more dramatic in patients hospitalised for a hip fracture, because about 3/4 of them have one or more vertebral deformities. It is important to detect these vertebral deformities because they represent a significantly higher risk to have subsequent fractures, particularly vertebral (approximately 5x), but also hip fractures (approximately 2x). This risk remains increased, whatever is the number or the grade of the deformities, although it is higher in patients with many fractures or with severe deformities. It is also important to detect vertebral deformities, because cost-effectiveness of treatments such as bisphosphonates, calcitonin, raloxifen, or PTH is the highest in patients with prevalent vertebral deformities. Unfortunately, only 1/3 of vertebral deformities are diagnosed. In consequence, it is of major importance to develop screening and diagnosis strategies for these deformities. Morphologic vertebral assessment by DXA should be an interesting approach for this purpose.
50岁女性发生影像学椎体骨折（椎体畸形）的终生风险超过30%。在50至79岁的女性中，12%至20%的人有一处或多处椎体畸形。在瑞士，这意味着约13万至22万女性。对于男性，此类骨折的全球患病率相同。然而，男性通常发生在遭受比女性更大创伤的较年轻男性身上。因髋部骨折住院的患者情况更为严重，因为约四分之三的患者有一处或多处椎体畸形。检测到这些椎体畸形很重要，因为它们会显著增加后续骨折的风险，尤其是椎体骨折（约5倍），还有髋部骨折（约2倍）。无论畸形的数量或程度如何，这种风险都会增加，尽管在多处骨折或严重畸形的患者中风险更高。检测椎体畸形也很重要，因为对于患有椎体畸形的患者，双膦酸盐、降钙素、雷洛昔芬或甲状旁腺激素等治疗的成本效益最高。不幸的是，只有三分之一的椎体畸形得到诊断。因此，制定针对这些畸形的筛查和诊断策略至关重要。通过双能X线吸收法（DXA）进行形态学椎体评估可能是实现这一目的的一种有效方法。
