Wáng Yì Xiáng J, Lu Zhi-Hui, Leung Jason C S, Fang Ze-Yu, Kwok Timothy C Y
Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
Quant Imaging Med Surg. 2023 Feb 1;13(2):1115-1125. doi: 10.21037/qims-2022-06. Epub 2022 Dec 1.
For osteoporotic fractures in men (MrOS) and in women (MsOS) (Hong Kong) baseline (BL) study, Chinese men and women ≥65 years were recruited during 2001 to 2003. This study presents the year-18 follow-up (FU) results. We were particularly interested in whether women with 'minimal' grade osteoporotic-like vertebral fracture (OLVF) of <20% height loss have an increased vertebral fracture (VF) risk than those without BL OLVF.
At year-18 FU, spine radiography was performed on 144 males (mean: 87.4±3.1 years) and 156 females (mean: 87.0±3.2 years). OLVF classification included no OLVF (grade 0), and OLVFs with <20%, ≥20-25%, ≥25%-1/3, ≥1/3-40%, ≥40%-2/3, ≥2/3 height loss (grades 1-6). With an existing OLVF, a further height loss of ≥15% was an OLVF progression. A new incident OLVF was a change from grade 0 to ≥ grade 2 or to grade 1 with the appearance of endplate and/or cortex fracture (ECF) during FU. Both OLVF progression and incident OLVF were considered incident VF. Acquired short vertebra (aSV) was defined as with decreased vertebral anterior and middle heights, while without anterior wedging and bi-concave changes, and only those with at least two adjacent aSVs were recorded as aSV cases.
For subjects without BL OLVF, 12.5% of the males and 27.1% of the females had incident VF. For subjects with BL OLVF of ≥20% height loss, males' and females' incident VF rate were 20% and 66.7% respectively. Females subjects with BL minimal OLVF, while all without radiographic ECF, had an incident VF rate of 59.3% during the FU. For males with and without aSV, 11.8% and 15% have incident fracture of other vertebrae. For females with and without aSV, 35.3% and 34.5% have incident fracture of other vertebrae. Recovery from minimal or mild grades OLVF to normal shape was observed in a number of cases.
OLVF with less than 20% height loss is associated with increased VF risk in older females, but not in older males. Acquired short vertebra (SV) is not associated with increased incident fracture risk for other vertebrae, both for females and males. OLVF among older subjects can repair and heal.
在男性骨质疏松性骨折（MrOS）和女性骨质疏松性骨折（MsOS）（香港）基线（BL）研究中，2001年至2003年招募了年龄≥65岁的中国男性和女性。本研究展示了18年随访（FU）结果。我们特别感兴趣的是，椎体高度丢失<20%的“轻度”骨质疏松样椎体骨折（OLVF）女性与无基线OLVF的女性相比，椎体骨折（VF）风险是否增加。
在18年随访时，对144名男性（平均年龄：87.4±3.1岁）和156名女性（平均年龄：87.0±3.2岁）进行了脊柱X线摄影。OLVF分类包括无OLVF（0级），以及椎体高度丢失<20%、≥20%-25%、≥25%-1/3、≥1/3-40%、≥40%-2/3、≥2/3的OLVF（1-6级）。对于现有的OLVF，椎体高度进一步丢失≥15%为OLVF进展。新发生的OLVF是指在随访期间从0级变为≥2级，或变为1级且出现终板和/或皮质骨折（ECF）。OLVF进展和新发生的OLVF均被视为新发VF。获得性短椎体（aSV）定义为椎体前部和中部高度降低，但无前楔形和双凹形改变，只有至少有两个相邻aSV的病例才被记录为aSV病例。
对于无基线OLVF的受试者，男性和女性新发VF的比例分别为12.5%和27.1%。对于椎体高度丢失≥20%的基线OLVF受试者，男性和女性的新发VF率分别为20%和66.7%。基线OLVF程度最轻的女性受试者，虽然均无影像学ECF，但在随访期间新发VF率为59.3%。有和无aSV的男性中，分别有11.8%和15%发生其他椎体的新发骨折。有和无aSV 的女性中，分别有35.3%和34.5%发生其他椎体的新发骨折。在一些病例中观察到从轻度或中度OLVF恢复到正常形态。
椎体高度丢失小于20%的OLVF与老年女性VF风险增加相关，但与老年男性无关。获得性短椎体（SV）与女性和男性其他椎体的新发骨折风险增加无关。老年受试者中的OLVF可以修复和愈合。
