McDaniels-Davidson Corinne R, Kritz-Silverstein Donna, Huang Mei-Hua, Laughlin Gail A, Johnson Sarah, Haapalahti Jouko, Schneider Diane L, Barrett-Connor Elizabeth, Kado Deborah M
San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Epidemiology), 9500 Gilman Drive, MC 0725, La Jolla, CA 92093, United States.
Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, San Diego, CA, United States.
Bone Rep. 2016 Apr 8;5:57-61. doi: 10.1016/j.bonr.2016.04.001. eCollection 2016 Dec.
Hyperkyphosis, accentuated curvature of the thoracic spine, is often attributed to osteoporosis, yet its underlying pathophysiology is not well understood. Bone turnover markers (BTM) reflect the dynamic process of bone formation and resorption. This study examined the association between serum BTM levels and kyphosis in community-dwelling older adults.
Between 2003 and 2006, 760 men and women in the Rancho Bernardo Study age 60 and older had blood drawn and kyphosis measured. Fasting serum was assayed for N-telopeptide (NTX) and procollagen type 1 n-terminal propeptide (P1NP), markers of bone resorption and formation, respectively. Participants requiring two or more 1.7 cm blocks under their head to achieve a neutral supine position were classified as having accentuated kyphosis. Analyses were stratified by sex and use of estrogen therapy (ET). Odds of accentuated kyphosis were calculated for each standard deviation increase in log-transformed BTM.
Mean age was 75 years. Overall, 51% of 341 non-ET using women, 41% of 111 ET-using women, and 75% of 308 men had accentuated kyphosis. In adjusted models, higher P1NP and NTX were associated with decreased odds of accentuated kyphosis in non-ET using women (P1NP: OR = 0.78 [95% CI, 0.58-0.92]; NTX: OR = 0.68 [95% CI, 0.54-0.86]), but not in men or ET-using women ( > 0.05).
The selective association of higher bone turnover with reduced odds of accentuated kyphosis in non-ET using women suggests that elevated BTM were associated with a lower likelihood of hyperkyphosis only in the low estrogen/high BTM environment characteristic of postmenopausal women who are not using ET.
胸椎后凸畸形，即胸椎的异常弯曲，通常被认为与骨质疏松症有关，但其潜在的病理生理学机制尚未完全明确。骨转换标志物（BTM）反映了骨形成和吸收的动态过程。本研究旨在探讨社区居住的老年人血清BTM水平与脊柱后凸之间的关联。
在2003年至2006年期间，对兰乔贝纳多研究中760名年龄在60岁及以上的男性和女性进行了血液抽取和脊柱后凸测量。空腹血清分别检测了骨吸收标志物N-端肽（NTX）和骨形成标志物1型前胶原N-端前肽（P1NP）。那些头部下方需要两个或更多1.7厘米垫块才能达到中立仰卧位的参与者被归类为有明显的脊柱后凸。分析按性别和雌激素治疗（ET）的使用情况进行分层。计算log转换后的BTM每增加一个标准差时明显脊柱后凸的几率。
平均年龄为75岁。总体而言，341名未使用ET的女性中有51%、111名使用ET的女性中有41%以及308名男性中有75%有明显的脊柱后凸。在调整后的模型中，较高的P1NP和NTX与未使用ET的女性中明显脊柱后凸几率的降低相关（P1NP：OR = 0.78 [95% CI，0.58 - 0.92]；NTX：OR = 0.68 [95% CI，0.54 - 0.86]），但在男性或使用ET的女性中无此关联（P > 0.05）。
较高的骨转换与未使用ET的女性中明显脊柱后凸几率降低之间的选择性关联表明，仅在未使用ET的绝经后女性的低雌激素/高BTM环境中，升高的BTM与较低的胸椎后凸可能性相关。
