Service de Rhumatologie, Hôpital Edouard Herriot, Pavillon F, Lyon.
Faculté de Médecine, Université Claude Bernard Lyon 1.
Rheumatology (Oxford). 2021 May 14;60(5):2197-2205. doi: 10.1093/rheumatology/keaa517.
To analyse the risk of incident vertebral and non-vertebral fracture in men with DISH.
In 782 men ages 50-85 years, DISH was diagnosed using Resnick's criteria. In men followed prospectively for 7.5 years, a radiographic incident vertebral fracture was defined by a decrease of ≥20% or ≥4mm in any vertebral height vs baseline. Self-reported incident non-vertebral fractures were confirmed by medical records.
Men with DISH had higher BMD at the lumbar spine (P < 0.05), but not at other skeletal sites. After adjustment for confounders including disc space narrowing (DSN) and endplate irregularity, the risk of vertebral fracture was higher in men with DISH vs men without DISH [10/164 (6.1%) vs 16/597 (2.7%), P < 0.05; odds ratio (OR) 2.89 (95% CI 1.15, 7.28), P < 0.05]. DISH and low spine BMD were each associated with a higher vertebral fracture risk. The vertebral fracture risk was higher in men who had both DISH and severe DSN. DISH and endplate irregularities (EIs) were each associated with higher vertebral fracture risk. DISH, DSN and EIs define the intervertebral space dysfunction, which was associated with higher vertebral fracture risk [OR 3.99 (95% CI 1.45, 10.98), P < 0.01]. Intervertebral space dysfunction improved the vertebral fracture prediction (ΔAUC = +0.111, P < 0.05), mainly in men with higher spine BMD (>0.9 g/cm2; ΔAUC = +0.189, P < 0.001). DISH was not associated with the risk of non-vertebral fracture.
DISH is associated with higher vertebral fracture risk, independently of other risk factors. Assessment of the intervertebral space dysfunction components may improve the vertebral fracture prediction in older men.
分析弥漫性特发性骨肥厚（DISH）患者发生椎体和非椎体骨折的风险。
在 782 名年龄在 50-85 岁的男性中，使用 Resnick 标准诊断 DISH。对前瞻性随访 7.5 年的男性，通过任何椎体高度相对于基线下降≥20%或≥4mm 定义为放射性椎体骨折。通过病历证实报告的非椎体骨折。
DISH 男性的腰椎骨密度（BMD）较高（P<0.05），但其他骨骼部位的 BMD 没有差异。调整椎间盘狭窄（DSN）和终板不规则等混杂因素后，与无 DISH 男性相比，DISH 男性的椎体骨折风险更高[10/164（6.1%）比 16/597（2.7%），P<0.05；比值比（OR）2.89（95%CI 1.15，7.28），P<0.05]。DISH 和低脊柱 BMD 均与更高的椎体骨折风险相关。同时患有 DISH 和严重 DSN 的男性椎体骨折风险更高。DISH 和终板不规则（EIs）均与更高的椎体骨折风险相关。DISH、DSN 和 EIs 定义了椎间隙功能障碍，与更高的椎体骨折风险相关[OR 3.99（95%CI 1.45，10.98），P<0.01]。椎间隙功能障碍改善了椎体骨折预测（ΔAUC=+0.111，P<0.05），主要在脊柱 BMD 较高的男性中（>0.9g/cm2；ΔAUC=+0.189，P<0.001）。DISH 与非椎体骨折风险无关。
DISH 与更高的椎体骨折风险相关，独立于其他危险因素。评估椎间隙功能障碍成分可能会提高老年男性的椎体骨折预测。
