老年人的过度脊柱后凸与死亡风险：男性骨质疏松性骨折研究。
Hyperkyphosis and mortality risk in older men: The osteoporotic fractures in men study.
机构信息
Department of Medicine, Stanford University, Stanford, California, USA.
Division of Geriatrics, University of California, Los Angeles, California, USA.
出版信息
J Am Geriatr Soc. 2023 Feb;71(2):496-504. doi: 10.1111/jgs.18100. Epub 2022 Oct 28.
INTRODUCTION
Hyperkyphosis commonly affects older people but is not widely acknowledged as a clinically actionable problem, especially in men. There are several techniques to quantify kyphosis including the blocks and Cobb angle measurements. This study includes both kyphosis measures to investigate whether older men with accentuated kyphosis may be at increased mortality risk.
METHODS
Men aged ≥65 years (N = 5994) were recruited to participate in the MrOS prospective cohort study from 2000 to 2002 (baseline). Our primary cohort included 2931 enrollees (mean age 79.3 years; SD 5.2) who underwent blocks-measured kyphosis from 2006 to 2009. Our secondary cohort included 2351 participants who underwent radiographic Cobb angle measurements at baseline. Cox proportional hazards analyses were used to determine association between kyphosis and all-cause mortality while adjusting for prevalent radiographic vertebral fractures, bone mineral density, incident fractures, gait speed, timed chair stands, self-reported health, alcohol use, medical co-morbidities, and physical activity.
RESULTS
During a mean follow-up of 8.3 (SD 3.2) years, 1393 participants died in the primary cohort. In this group, compared to men with 0-1 block kyphosis, increasing blocks-measured kyphosis was associated with increased mortality (HR: 1.26-1.53, p trend <0.001). With addition of prevalent vertebral fracture to adjusted models, the association remained significant in participants with severe kyphosis (3+ blocks-measured). Similarly, with addition of chair stand performance the association remained significant for 4+ blocks kyphosis. Walking speed did not attenuate the association of kyphosis and mortality. In the secondary cohort, there were no significant associations between radiographic Cobb angle kyphosis and mortality.
CONCLUSIONS
Increasing blocks-measured kyphosis was associated with a greater risk of mortality in older men, indicating that hyperkyphosis identified on physical exam should be considered a clinically significant finding that may warrant further evaluation and treatment.
引言
脊柱后凸在老年人中较为常见，但并未被广泛认为是一个具有临床可操作性的问题，尤其是在男性中。有几种方法可以量化脊柱后凸，包括椎体楔形块和 Cobb 角测量。本研究同时使用了这两种方法来研究是否存在严重脊柱后凸的老年男性死亡率更高。
方法
2000 年至 2002 年（基线），招募了年龄≥65 岁的男性（n=5994）参与 MrOS 前瞻性队列研究。我们的主要队列包括 2931 名参与者（平均年龄 79.3 岁；标准差 5.2），他们在 2006 年至 2009 年期间接受了椎体楔形块测量的脊柱后凸检查。我们的次要队列包括 2351 名参与者，他们在基线时接受了放射学 Cobb 角测量。使用 Cox 比例风险分析来确定脊柱后凸与全因死亡率之间的关联，同时调整了基线时存在的放射学椎体骨折、骨密度、新发骨折、步态速度、定时椅站立、自我报告的健康状况、饮酒、合并症和身体活动。
结果
在平均 8.3（标准差 3.2）年的随访期间，主要队列中有 1393 名参与者死亡。在该组中，与椎体楔形块测量后凸为 0-1 块的男性相比，椎体楔形块测量后凸增加与死亡率增加相关（HR：1.26-1.53，p 趋势<0.001）。在调整模型中加入椎体骨折后，严重脊柱后凸（3 块以上椎体楔形块）患者的相关性仍然显著。同样，在加入椅站立表现后，4 块以上椎体楔形块的相关性仍然显著。行走速度并没有削弱脊柱后凸与死亡率之间的关联。在次要队列中，放射学 Cobb 角脊柱后凸与死亡率之间没有显著关联。
结论
椎体楔形块测量的脊柱后凸增加与老年男性死亡率增加相关，这表明体格检查中发现的脊柱后凸应被视为具有临床意义的发现，可能需要进一步评估和治疗。
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