Roux J P, Belghali S, Wegrzyn J, Rendu E S, Chapurlat R
INSERM, UMR 1033, Université de Lyon, Lyon, France.
Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Lyon, France.
Osteoporos Int. 2016 Aug;27(8):2507-13. doi: 10.1007/s00198-016-3558-y. Epub 2016 Mar 8.
We investigate the predictive role of vertebral anterior cortical curvature and height heterogeneity in the occurrence of vertebral fractures in postmenopausal women. Women who will fracture had shorter vertebral height, greater heterogeneity of height than those who will not fracture, and their anterior vertebral body edge was less concave.
Vertebral morphology has been demonstrated to be associated with further risk of fracture. The aim of this study was to analyze vertebral anterior cortical curvature (Ct.curv) and vertebral height heterogeneity in postmenopausal women before the occurrence of a vertebral fracture.
This case-control study included 29 postmenopausal women who have underwent incident lumbar vertebral fractures (mean age 71 ± 9 years, mean time to fractures 9 ± 4 years), age-matched with 57 controls. From lateral X-rays of lumbar spine radiographs (T12 to L4), the following parameters were measured: (1) the posterior, middle, and anterior vertebral heights; (2) the heterogeneity of heights evaluated by the coefficient of variation of these three variables; (3) antero-posterior width, a 2D estimator of cross-sectional area; and (4) Ct.curv.
Mean vertebral heights were significantly lower among women who fractured than in controls (p < 0.05). The anterior and middle heights were significantly lower at L4 and L3 levels in fracture group (p = 0.02). The heterogeneity of vertebral height was significantly greater in the fracture group (p = 0.003). In addition, fractured patients had a significantly higher Ct.curv on L3 (p = 0.04). After adjustment for bone mineral density (BMD), only the heterogeneity of vertebral height remained significant (p = 0.005).
The current case-control study confirmed the association between vertebral height and occurrence of future vertebral fracture in postmenopausal women. The vertebrae with the smallest Ct.curv tended to fracture less often, and the heterogeneity of vertebral heights was associated with future fracture independently of BMD. An additional validation in a prospective study would be needed to confirm these initial results.
我们研究了绝经后女性椎体前皮质曲率和高度异质性在椎体骨折发生中的预测作用。将会发生骨折的女性椎体高度较短，高度异质性比不会发生骨折的女性更大，且其椎体前缘凹陷程度较小。
椎体形态已被证明与进一步发生骨折的风险相关。本研究的目的是分析绝经后女性在椎体骨折发生前的椎体前皮质曲率（Ct.curv）和椎体高度异质性。
这项病例对照研究纳入了29例经历过新发腰椎椎体骨折的绝经后女性（平均年龄71±9岁，距骨折的平均时间为9±4年），与57例年龄匹配的对照者。从腰椎X线侧位片（T12至L4）测量以下参数：（1）椎体后、中、前高度；（2）通过这三个变量的变异系数评估的高度异质性；（3）前后宽度，横截面面积的二维估计值；以及（4）Ct.curv。
发生骨折的女性的平均椎体高度显著低于对照组（p<0.05）。骨折组L4和L3水平的前高度和中高度显著更低（p = 0.02）。骨折组的椎体高度异质性显著更大（p = 0.003）。此外，骨折患者L3的Ct.curv显著更高（p = 0.04）。在调整骨密度（BMD）后，只有椎体高度异质性仍具有显著性（p = 0.005）。
当前的病例对照研究证实了绝经后女性椎体高度与未来椎体骨折发生之间的关联。Ct.curv最小的椎体往往骨折频率较低，且椎体高度异质性与未来骨折相关，独立于骨密度。需要在前瞻性研究中进行额外验证以证实这些初步结果。
