Department of Internal Medicine, Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands; The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), 2300 RC Leiden, The Netherlands; Department of Epidemiology, Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands.
Bone. 2013 Nov;57(1):284-9. doi: 10.1016/j.bone.2013.08.004. Epub 2013 Aug 17.
To investigate the relation between lumbar disc degeneration (LDD) and all type of osteoporotic (OP) fractures including vertebral.
This study is part of the Rotterdam study, a large prospective population-based cohort study among men and women aged 55years and over. In 2819 participants spine radiographs were scored for LDD (osteophytes and disc space narrowing (DSN)) from L1 till S1, using the Lane atlas. Osteoporotic (OP) fracture data were collected and verified by specialists during 12.8years. We considered two types of vertebral fractures (VFx): Clinical VFx (symptomatic fractures recorded by medical practitioners) and Radiographic VFx (using the McCloskey-Kanis method). Meta-analysis of published studies reporting an association of LDD features and VFx was performed. Differences in Bone Mineral Density (BMD) between participants with and without LDD features were analyzed using ANOVA. Risk of OP-fractures was analyzed using Cox regression.
In a total of 2385 participants, during 12.8years follow-up, 558 suffered an OP-fracture. Subjects with LDD had an increased OP fracture risk compared to subjects without LDD (HR: 1.29, CI: 1.04-1.60). LDD-cases have between 0.3 and 0.72 standard deviations more BMD than non-cases in all analyzed regions including total body BMD and skull BMD (P<0.001). Only males with LDD had increased risk for OP-fractures compared to males without LDD (adjusted-HR: 1.80, 95%CI: 1.20-2.70, P=0.005). The risk was also higher for VFx in males (HR: 1.64, CI: 1.03-2.60, P: 0.04). The association LDD-OP-fractures in females was lower and not significant (adjusted-HR: 1.08, 95%CI: 0.82-1.41). Meta-analyses showed that the risk of VFx in subjects with LDD has been studied only in women and there is not enough evidence to confidently analyze the relationship between LDD-features (DSN or/and OPH) and VFx due to low power and heterogeneity in phenotype definition in the collected studies.
Male subjects with LDD have a higher osteoporotic fracture risk, in spite of systemically higher BMD.
研究腰椎间盘退变（LDD）与包括椎体在内的所有类型骨质疏松性（OP）骨折之间的关系。
本研究是鹿特丹研究的一部分，这是一项针对 55 岁及以上男性和女性的大型前瞻性人群队列研究。在 2819 名参与者中，使用 Lane 图谱对 L1 至 S1 的脊柱 X 光片进行 LDD（骨赘和椎间盘空间变窄（DSN））评分。在 12.8 年期间，由专家收集和验证骨质疏松性（OP）骨折数据。我们考虑了两种类型的椎体骨折（VFx）：临床 VFx（由医务人员记录的有症状骨折）和放射学 VFx（使用 McCloskey-Kanis 方法）。对报告 LDD 特征与 VFx 之间关联的已发表研究进行了荟萃分析。使用方差分析分析了有和无 LDD 特征的参与者之间骨密度（BMD）的差异。使用 Cox 回归分析了 OP 骨折的风险。
在总共 2385 名参与者中，在 12.8 年的随访期间，有 558 人发生了 OP 骨折。与无 LDD 的参与者相比，有 LDD 的参与者发生 OP 骨折的风险更高（HR：1.29，CI：1.04-1.60）。在所有分析区域（包括全身 BMD 和颅骨 BMD）中，LDD 病例的 BMD 比非病例高 0.3 到 0.72 个标准差（P<0.001）。只有男性 LDD 患者与无 LDD 患者相比，OP 骨折风险更高（调整后的 HR：1.80，95%CI：1.20-2.70，P=0.005）。男性 VFx 的风险也更高（HR：1.64，CI：1.03-2.60，P：0.04）。女性 LDD-OP 骨折的相关性较低且不显著（调整后的 HR：1.08，95%CI：0.82-1.41）。荟萃分析表明，在有 LDD 的受试者中 VFx 的风险仅在女性中进行了研究，由于在收集的研究中表型定义的低效力和异质性，没有足够的证据可以有信心地分析 LDD 特征（DSN 或/和 OPH）与 VFx 之间的关系。
尽管系统 BMD 较高，但有 LDD 的男性受试者发生骨质疏松性骨折的风险更高。
