Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Science Malmö, Lund University, and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
Osteoporos Int. 2013 Apr;24(4):1419-28. doi: 10.1007/s00198-012-2048-0. Epub 2012 Jun 26.
Degenerative changes of the lumbar spine may lead to misinterpretation of bone mineral density (BMD) measurements and cause underdiagnosis of osteoporosis. This longitudinal study of 1,044 women, 75 years at inclusion and followed for 10 years, shows that identification of apparent degenerative changes on the dual energy X-ray absorptiometry (DXA) scan can increase the proportion diagnosed.
In the elderly, degenerative manifestations in the lumbar spine may result in falsely elevated BMD values, consequently missing a large proportion of those with osteoporosis. Our aim was to determine the distribution and impact of degenerative changes on lumbar spine DXA over time and its clinical implications.
Participants were 1,044 women from the population-based Osteoporosis Risk Assessment cohort. All women were 75 years old at invitation and followed up after 5 years (n=715) and 10 years (n=382). Degenerative changes were evaluated visually on the DXA image for each vertebra L1 to L4 (intraobserver precision kappa values of 0.66-0.70).
At baseline, apparent degenerative changes were more frequent in the inferior segments of the lumbar spine [5% (L1), 15% (L2), 26% (L3), and 36% (L4)] and increased over time. At 10 years, the prevalences were 20% (L1), 39% (L2), 59% (L3), 72% (L4), resulting in a significant increase in overall BMD. In women without apparent degenerative changes, BMD remained stable between 75 and 85 rather than an expected bone loss. At baseline, 37% had osteoporosis (BMD<-2.5) at L1-L4; exclusion of women with apparent degenerative changes increased this proportion to 47%. Using L1-L2, which was less prone to degenerative changes, 46% of women were classified as osteoporotic regardless of degenerative changes.
Degenerative changes were very common in elderly women, accelerated disproportionately over time, were increasingly frequent from vertebrae L1 to L4, and had significant impact on diagnosing osteoporosis. This suggests that routine reporting of spine BMD at L1-L2 would add valuable information for reassessment and monitoring.
腰椎的退行性改变可能导致骨密度（BMD）测量值的误读，并导致骨质疏松症的漏诊。这项对 1044 名 75 岁女性的纵向研究，在 10 年内进行了随访，结果表明，在双能 X 射线吸收法（DXA）扫描中识别明显的退行性改变可以增加诊断的比例。
确定腰椎 DXA 随时间推移的退行性变化的分布和影响及其临床意义。
参与者为来自人群为基础的骨质疏松风险评估队列的 1044 名女性。所有女性在邀请时均为 75 岁，并在 5 年（n=715）和 10 年（n=382）时进行了随访。对 L1 到 L4 每个椎骨的 DXA 图像进行视觉评估退行性变化（观察者内精度kappa 值为 0.66-0.70）。
在基线时，腰椎下段[5%（L1），15%（L2），26%（L3）和 36%（L4）]的退行性变化更为常见，并且随着时间的推移而增加。在 10 年时，退行性变化的患病率为 20%（L1），39%（L2），59%（L3），72%（L4），导致整体 BMD 显著增加。在没有明显退行性变化的女性中，75 至 85 岁之间的 BMD 保持稳定，而不是预期的骨质流失。在基线时，37%的女性在 L1-L4 处患有骨质疏松症（BMD<-2.5）；排除有明显退行性变化的女性后，这一比例增加到 47%。使用较少受退行性变化影响的 L1-L2，无论退行性变化如何，46%的女性都被归类为骨质疏松症。
退行性变化在老年女性中非常常见，随时间不成比例地加速，从 L1 到 L4 越来越频繁，对诊断骨质疏松症有显著影响。这表明，常规报告 L1-L2 的脊柱 BMD 将为重新评估和监测提供有价值的信息。
