Pettersen P C, de Bruijne M, Chen J, He Q, Christiansen C, Tankó L B
Center for Clinical and Basic Research, Ballerup Byvej 222, 2750 Ballerup, Denmark.
Osteoporos Int. 2007 Nov;18(11):1525-30. doi: 10.1007/s00198-007-0388-y. Epub 2007 May 22.
Prevalent fracture and BMD are core elements of fracture prediction. In this control study case, we demonstrate that a simple computer-based estimation of local irregularities in the alignment of the lumbar vertebrae independently contributes to the fracture risk, thus supplementing current diagnostic tools.
We tested the hypothesis that degree of lordosis and/or irregularity in the alignment of lumbar vertebrae could be contributors to the risk of fragility fractures.
This was a case-control analysis including 144 elderly women; 108 maintaining skeletal integrity, whereas 36 sustaining a lumbar vertebral fracture during a 7.5-year observation period. The two groups of women were carefully matched for age, BMI, spine BMD and numerous classic risk factors. Lateral X-rays of the lumbar spine were digitized and the four corner points of endplates on each vertebra from Th12 to L5 were annotated. The degree of lordosis and irregularity of vertebral alignment was assessed by image analysis software.
Degree of lordosis was not predictive for fractures. In contrast, irregularity was significantly higher in those who later sustained a fracture (1.6 x 10(-2)vs. 2.0 x 10(-3) cm(-1), p < 0.001), and further increased upon a sustained fracture (2.8 x 10(-2) cm(-1), p < 0.001), but was unchanged in controls (1.6 x 10(-2) cm(-1)). The predictive value of irregularity was independent of classic risk factors of fractures, including BMD (p < 0.01).
Our results suggest that the herein introduced simple measure of irregularities in vertebral alignment could provide useful supplement to the currently used diagnostic tools of fracture prediction in elderly women.
普遍存在的骨折和骨密度是骨折预测的核心要素。在本对照研究案例中，我们证明基于计算机对腰椎排列局部不规则性的简单估计独立地对骨折风险有影响，从而补充了当前的诊断工具。
我们检验了以下假设，即腰椎前凸程度和/或腰椎排列不规则可能是脆性骨折风险的影响因素。
这是一项病例对照分析，包括144名老年女性；108名保持骨骼完整性，而36名在7.5年观察期内发生了腰椎骨折。两组女性在年龄、体重指数、脊柱骨密度和众多经典风险因素方面进行了仔细匹配。腰椎侧位X线片被数字化，标记出从胸12到腰5每个椎体终板的四个角点。通过图像分析软件评估腰椎前凸程度和椎体排列不规则性。
腰椎前凸程度不能预测骨折。相比之下，后来发生骨折的患者其不规则性显著更高（1.6×10⁻²对2.0×10⁻³cm⁻¹，p<0.001），并且在持续骨折时进一步增加（2.8×10⁻²cm⁻¹，p<0.001），但在对照组中保持不变（1.6×10⁻²cm⁻¹）。不规则性的预测价值独立于骨折的经典风险因素，包括骨密度（p<0.01）。
我们的结果表明，本文引入的椎体排列不规则性的简单测量方法可为目前用于老年女性骨折预测的诊断工具提供有用的补充。
