van Dort Mayke J, Driessen Johanna Hm, Romme Elisabeth Apm, Geusens Piet, Willems Paul C, Smeenk Frank Wjm, Wouters Emiel Fm, van den Bergh Joop Pw
NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.
CAPHRI Care and Public Health Research Institute, Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.
J Bone Miner Res. 2019 May;34(5):859-866. doi: 10.1002/jbmr.3672. Epub 2019 Feb 27.
Greater kyphosis angles lead to increased loading on vertebral bodies in computational models. However, results about the relationship between severity of kyphosis and incident vertebral fracture (VF) risk have been conflicting. Therefore, the aim of this study was to evaluate associations between 1) prevalent VFs and severity of kyphosis, and 2) severity of kyphosis and incident VF risk in smokers with or without chronic obstructive pulmonary disease (COPD). Former and current smokers with or without COPD were included. CT scans were made at baseline, 1-year, and 3-year follow-up. VFs were evaluated on superposed sagittal CT reconstructions. Kyphosis was measured as the angle between the lines above T and below T or T . We included 1239 subjects (mean age 61.3 ± 8.0 years, 61.1% male, 80.6% with COPD), of whom 253 (20.4%) had a prevalent VF and 294 (23.7%) an incident VF within 3 years. Presence, number, and severity of prevalent VFs were associated with a greater kyphosis angle. The mean increase in kyphosis angle within 3 years was small but significantly greater in subjects with incident VFs compared with those without (2.2 ± 4.1 versus 1.2 ± 3.9 degrees, respectively, for T to T angle, p < 0.001). After adjustment for bone attenuation (BA) and prevalent VFs, baseline kyphosis angle was associated with incident VFs within 1 and 3 years (angle T to T per +1 SD, hazard ratio [HR] = 1.34 [1.12-1.61] and HR 1.29 [1.15-1.45], respectively). Our data showed that a greater kyphosis angle at baseline was independently associated with increased risk of incident VFs within 1 and 3 years, supporting the theory that greater kyphosis angle contributes to higher biomechanical loads in the spine. © 2019 American Society for Bone and Mineral Research.
在计算模型中，更大的脊柱后凸角度会导致椎体承受的负荷增加。然而，关于脊柱后凸严重程度与椎体骨折（VF）发生风险之间关系的研究结果一直存在矛盾。因此，本研究的目的是评估：1）现患椎体骨折与脊柱后凸严重程度之间的关联，以及2）在患有或未患有慢性阻塞性肺疾病（COPD）的吸烟者中，脊柱后凸严重程度与椎体骨折发生风险之间的关联。纳入了曾吸烟和目前仍在吸烟且患有或未患有COPD的人群。在基线、1年和3年随访时进行CT扫描。在叠加的矢状面CT重建图像上评估椎体骨折情况。脊柱后凸以T 上方和T 或T 下方的线之间的角度来测量。我们纳入了1239名受试者（平均年龄61.3±8.0岁，61.1%为男性，80.6%患有COPD），其中253人（20.4%）有现患椎体骨折，294人（23.7%）在3年内发生了椎体骨折。现患椎体骨折的存在、数量和严重程度与更大的脊柱后凸角度相关。3年内脊柱后凸角度的平均增加幅度较小，但发生椎体骨折的受试者与未发生椎体骨折的受试者相比，增加幅度显著更大（T 至T 角度分别为2.2±4.1度和1.2±3.9度，p<0.001）。在调整骨密度（BA）和现患椎体骨折因素后，基线脊柱后凸角度与1年和3年内的椎体骨折发生相关（T 至T 角度每增加1个标准差，风险比[HR]=分别为1.34[1.12 - 1.61]和HR 1.29[1.15 - 1.45]）。我们的数据表明，基线时更大的脊柱后凸角度与1年和3年内椎体骨折发生风险增加独立相关，这支持了更大的脊柱后凸角度会导致脊柱承受更高生物力学负荷的理论。©2019美国骨与矿物质研究学会。
