患病率和发病率的椎体骨折： 7 年的随访研究在机构化成年人难治性癫痫和智力残疾。
Prevalence and incidence of vertebral fractures: a 7-year follow-up study in institutionalized adults with refractory epilepsy and intellectual disability.
机构信息
Department of Residential Care, Epilepsy Center Kempenhaeghe, Heeze, the Netherlands.
Department of Neurology, Academic Center for Epileptology Kempenhaeghe, Maastricht University Medical Center, Heeze and Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
出版信息
Epilepsy Res. 2020 Nov;167:106461. doi: 10.1016/j.eplepsyres.2020.106461. Epub 2020 Sep 10.
OBJECTIVE
The main objective of this cohort study is to determine the prevalence and incidence of morphometric vertebral fractures (VFs) over 7 years follow-up, in institutionalized adults with refractory epilepsy and intellectual disability (ID).
METHODS
Dual-energy X-ray Absorptiometry (DXA) and Vertebral Fracture Assessment (VFA) were performed in 2009 and 2016. Vertebrae T4-L4 were assessed using quantitative morphometry. Severity of VFs was graded as 1 (mild; 20-25% reduction in height), 2 (moderate; 25-40% reduction) or 3 (severe; >40% reduction) according to the method described by Genant. Prevalent VFs were analyzed at baseline. VFs (grade 1, 2 or 3) present at follow-up, but not at baseline, were considered new VFs. Worsening VFs were defined as VFs with at least one grade deterioration at follow-up, compared to baseline (grade 1 to 2 or 3, or grade 2 to 3). Patients were treated with anti-osteoporosis treatment according to the Dutch guideline.
RESULTS
Baseline and follow-up DXA and VFA could be obtained in 141 patients (87 male) aged between 18-79 years old (mean 44.8 ± 15.7). At baseline, 56 patients had at least one prevalent VF. Patients with a prevalent VF were significantly older than patients without (49.2 ± 13.7 vs 41.9 ± 16.4, p < .01). After 7 years follow-up, 38 new VFs occurred in 27 patients and 15 patients had a worsening VF, leading to an overall cumulative incidence of 27.0%. VF incidence was significantly higher in patients with at least one prevalent VF at baseline (48.2% vs 12.9%, respectively, p < .01) compared to no VF.
SIGNIFICANCE
In adults with refractory epilepsy VFA is challenging, due to physical and behavioral aspects, resulting in a substantial proportion of unevaluable vertebrae and scans. Nevertheless, 40% of the patients had a VF at baseline and after 7 years follow-up, 27% had at least one new and/or worsening VF despite adequate anti-osteoporosis treatment.
目的
本队列研究的主要目的是确定在 7 年的随访中，患有难治性癫痫和智力障碍（ID）的机构化成年人中，形态计量性椎体骨折（VF）的发生率和患病率。
方法
2009 年和 2016 年进行双能 X 射线吸收法（DXA）和椎体骨折评估（VFA）。使用定量形态计量学评估 T4-L4 椎体。根据 Genant 描述的方法，将 VF 的严重程度分为 1 级（轻度；高度减少 20-25%）、2 级（中度；高度减少 25-40%）或 3 级（重度；高度减少>40%）。在基线时分析现患 VF。在随访时出现但在基线时不存在的 VF（1 级、2 级或 3 级）被认为是新发 VF。与基线相比，随访时至少有一个等级恶化的 VF 被定义为恶化的 VF（1 级变为 2 级或 3 级，或 2 级变为 3 级）。根据荷兰指南，对患者进行抗骨质疏松治疗。
结果
在 141 名年龄在 18-79 岁之间（平均 44.8 ± 15.7）的男性和女性患者中，可获得基线和随访时的 DXA 和 VFA。基线时，56 名患者至少有一个现患 VF。与无 VF 的患者相比，患有现患 VF 的患者年龄明显更大（49.2 ± 13.7 岁比 41.9 ± 16.4 岁，p <.01）。在 7 年的随访后，27 名患者中有 38 例新发 VF，15 名患者出现 VF 恶化，总累积发生率为 27.0%。与无 VF 相比，基线时至少有一个现患 VF 的患者 VF 发生率显著更高（分别为 48.2%和 12.9%，p <.01）。
意义
在患有难治性癫痫的成年人中，由于身体和行为方面的原因，VFA 具有挑战性，导致大量椎体和扫描无法评估。然而，40%的患者在基线时有 VF，在 7 年的随访后，尽管进行了适当的抗骨质疏松治疗，仍有 27%的患者至少有一个新发和/或恶化的 VF。
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