Kobayashi T, Takeda N, Atsuta Y, Matsuno T
Department of Orthopaedic Surgery, Asahikawa Medical College, Asahikawa, Japan.
Osteoporos Int. 2008 Jan;19(1):65-9. doi: 10.1007/s00198-007-0432-y. Epub 2007 Sep 14.
In a 12-year prospective study of 100 adult volunteers, incident vertebral fractures were analyzed for potential predictors. Decreased sagittal spinal curvature and pre-existing fractures were identified as independent predictors. The risk of vertebral fracture increased to 8.6-fold with a 1 SD decrease in both thoracic and lumbar curves.
Physiological spinal curvature acts as a shock absorber: however, it has not been demonstrated whether reduced spinal curvature is a risk of vertebral fracture. The aim of this prospective study is to assess the relationship between the extent of sagittal spinal curvature and incidence of vertebral fractures.
One hundred community-based volunteers aged 50+ years were followed radiologically for at least 10 years. Entire spine radiograms of volunteers in erect position were used for evaluating sagittal spinal curvatures, grade of osteoporosis, and incident vertebral fractures.
Mean baseline age was 61.9 years and mean follow-up period was 12.0 years. In multivariate analysis, preexisting vertebral fracture (relative risk [RR] 3.70, 95% confidence interval [CI] 1.22-11.20), and a decrease in either thoracic or lumbar curvature by 1-SD (RR 3.06, 95% CI 1.04-9.00) were independent predictors. The fracture risk even increased in the presence of a 1-SD decrease in both thoracic and lumbar curvature (RR 8.64, 95% CI 1.39-53.78).
Reduction of physiological curvatures in both thoracic and lumbar spine led to the increased risk of vertebral fracture by more than eightfold. The importance of evaluating sagittal spinal alignment should be emphasized, because it might indicate the risk of the first vertebral fracture, which is another strong predictor of subsequent fractures.
在一项针对100名成年志愿者的12年前瞻性研究中，对新发椎体骨折的潜在预测因素进行了分析。矢状面脊柱曲度减小和既往存在的骨折被确定为独立预测因素。胸腰段曲线每降低1个标准差，椎体骨折风险增加至8.6倍。
生理性脊柱曲度起到减震器的作用；然而，脊柱曲度减小是否是椎体骨折的危险因素尚未得到证实。这项前瞻性研究的目的是评估矢状面脊柱曲度程度与椎体骨折发生率之间的关系。
对100名年龄在50岁及以上的社区志愿者进行了至少10年的放射学随访。志愿者站立位的全脊柱X线片用于评估矢状面脊柱曲度、骨质疏松程度和新发椎体骨折情况。
平均基线年龄为61.9岁，平均随访期为12.0年。多因素分析显示，既往椎体骨折（相对危险度[RR] 3.70，95%置信区间[CI] 1.22 - 11.20）以及胸段或腰段曲度降低1个标准差（RR 3.06，95% CI 1.04 - 9.00）是独立预测因素。胸腰段曲度均降低1个标准差时，骨折风险甚至更高（RR 8.64，95% CI 1.39 - 53.78）。
胸腰段脊柱生理性曲度减小导致椎体骨折风险增加超过八倍。应强调评估矢状面脊柱排列的重要性，因为它可能提示首次椎体骨折的风险，而首次椎体骨折是后续骨折的另一个重要预测因素。
