Watt Jennifer, Crilly Richard
Division of Geriatric Medicine, University of Toronto, 4-002 Shuter Wing, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
Division of Geriatric Medicine, University of Western Ontario, London, ON, Canada.
Calcif Tissue Int. 2017 Apr;100(4):412-419. doi: 10.1007/s00223-017-0244-9. Epub 2017 Feb 17.
The upper and lower thoracolumbar spine have been associated with different biomechanical outcomes. This concept, as it applies to osteoporotic fracture risk, has not been well documented. This was a case-control study of 120 patients seen in an osteoporosis clinic. Vertebral fractures were identified from lateral radiographs using Genant's semi-quantitative assessment method. An association between bone mineral density (BMD) T-scores and vertebral fracture location was assessed. In an additional analysis, the association between a history of any traumatic injury and possible predictor variables was also explored. The median age of patients was 75 (IQR 67-80), and 84.2% of patients were female. A history of trauma was reported by 46.7% of patients. A vertebral fracture in the lower thoracolumbar spine (T11-L4) was associated with significantly higher femoral neck (p < 0.001), lumbar (p = 0.005), trochanteric (p = 0.002), intertrochanteric (p < 0.001), and total hip (p = 0.0006) BMD T-scores. The odds of having a femoral neck (OR 0.24, 95% CI 0.07-0.75, p = 0.01) or total hip (OR 0.19, 95% CI 0.06-0.65, p = 0.008) T-score less than -2.5 was also lower among patients with vertebral fractures in the lower thoracolumbar spine. A fracture in the upper thoracolumbar spine (T4-T10) decreased the odds of having a history of traumatic injury (OR 0.32, 95% CI 0.14-0.76, p = 0.01), while a non-vertebral fracture increased the odds of such an injury (OR 2.41, 95% CI 1.10-5.32, p = 0.03). Vertebral fractures in the lower thoracolumbar spine are associated with higher BMD T-scores. This should be studied further to understand possible correlations with patients' future fracture risk.
胸腰段脊柱的上半部分和下半部分与不同的生物力学结果相关。这一概念，就其与骨质疏松性骨折风险的关系而言，尚未得到充分的文献记载。这是一项对在骨质疏松门诊就诊的120例患者进行的病例对照研究。使用Genant的半定量评估方法从侧位X线片中识别椎体骨折。评估骨密度（BMD）T值与椎体骨折部位之间的关联。在另一项分析中，还探讨了任何创伤史与可能的预测变量之间的关联。患者的中位年龄为75岁（四分位间距67 - 80岁），84.2%的患者为女性。46.7%的患者报告有创伤史。胸腰段脊柱下半部分（T11 - L4）的椎体骨折与股骨颈（p < 0.001）、腰椎（p = 0.005）、大转子（p = 0.002）、转子间（p < 0.001）和全髋（p = 0.0006）的BMD T值显著更高相关。胸腰段脊柱下半部分椎体骨折的患者股骨颈（OR 0.24，95% CI 0.07 - 0.75，p = 0.01）或全髋（OR 0.19，95% CI 0.06 - 0.65，p = 0.008）T值低于 -2.5的几率也更低。胸腰段脊柱上半部分（T4 - T10）的骨折降低了有创伤史的几率（OR 0.32，95% CI 0.14 - 0.76，p = 0.01），而非椎体骨折则增加了这种损伤的几率（OR 2.41，95% CI 1.10 - 5.32，p = 0.03）。胸腰段脊柱下半部分的椎体骨折与更高的BMD T值相关。对此应进一步研究以了解与患者未来骨折风险的可能相关性。
