Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY.
Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Spine (Phila Pa 1976). 2023 Jul 15;48(14):984-993. doi: 10.1097/BRS.0000000000004683. Epub 2023 Apr 10.
Prospective cross-sectional study.
To determine if an accumulation of advanced glycation endproducts (AGEs) is associated with impaired paraspinal muscle composition.
Impaired bone integrity and muscle function are described as osteosarcopenia. Osteosarcopenia is associated with falls, fragility fractures, and reduced quality of life. Bone integrity is influenced by bone quantity (bone mineral density) and quality (microarchitecture and collagen). The accumulation of AGEs stiffens collagen fibers and increases bone fragility. The relationship between paraspinal muscle composition and bone collagen properties has not been evaluated.
Intraoperative bone biopsies from the posterior superior iliac spine were obtained and evaluated with multiphoton microscopy for fluorescent AGE cross-link density (fAGEs). Preoperative magnetic resonance imaging measurements at level L4 included the musculus (m.) psoas and combined m. multifidus and m. erector spinae (posterior paraspinal musculature, PPM). Muscle segmentation on axial images (cross-sectional area, CSA) and calculation of a pixel intensity threshold method to differentiate muscle (functional cross-sectional area, fCSA) and intramuscular fat (FAT). Quantitative computed tomography was performed at the lumbar spine. Univariate and multivariable regression models were used to investigate associations between fAGEs and paraspinal musculature.
One hundred seven prospectively enrolled patients (50.5% female, age 60.7 y, BMI 28.9 kg/m 2 ) were analyzed. In all, 41.1% and 15.0% of the patients demonstrated osteopenia and osteoporosis, respectively. Univariate linear regression analysis demonstrated a significant association between cortical fAGEs and CSA in the psoas (ρ=0.220, P =0.039) but not in the PPM. Trabecular fAGEs revealed no significant associations to PPM or psoas musculature. In the multivariable analysis, higher cortical fAGEs were associated with increased FAT (β=1.556; P =0.002) and CSA (β=1.305; P =0.005) in the PPM after adjusting for covariates.
This is the first investigation demonstrating that an accumulation of nonenzymatic collagen cross-linking product fAGEs in cortical bone is associated with increased intramuscular fat in the lumbar paraspinal musculature.
前瞻性横断面研究。
确定晚期糖基化终产物（AGEs）的积累是否与脊柱旁肌肉成分受损有关。
骨完整性和肌肉功能受损被描述为骨-肌减少症。骨-肌减少症与跌倒、脆性骨折和生活质量下降有关。骨完整性受骨量（骨矿物质密度）和质量（微结构和胶原）的影响。AGEs 的积累会使胶原纤维变硬，增加骨脆性。脊柱旁肌肉成分与骨胶原特性之间的关系尚未得到评估。
从后上髂嵴获得术中骨活检，并使用多光子显微镜评估荧光 AGE 交联密度（fAGEs）。术前 L4 水平的磁共振成像测量包括腰大肌（m.）和多裂肌和竖脊肌（脊柱旁后部肌肉，PPM）的组合。在轴位图像上进行肌肉分割（横截面积，CSA）和计算像素强度阈值方法以区分肌肉（功能横截面积，fCSA）和肌内脂肪（FAT）。对腰椎进行定量计算机断层扫描。使用单变量和多变量回归模型研究 fAGEs 与脊柱旁肌肉之间的关联。
共分析了 107 例前瞻性入组患者（50.5%为女性，年龄 60.7 岁，BMI 28.9 kg/m 2 ）。共有 41.1%和 15.0%的患者分别表现为骨质疏松症和骨质疏松症。单变量线性回归分析表明，皮质 fAGEs 与腰大肌 CSA 之间存在显著相关性（ρ=0.220，P=0.039），但与 PPM 无相关性。小梁 fAGEs 与 PPM 或腰大肌肌肉无显著相关性。在多变量分析中，在调整协变量后，较高的皮质 fAGEs 与 PPM 中脂肪增加（β=1.556；P=0.002）和 CSA（β=1.305；P=0.005）相关。
这是第一项研究表明，皮质骨中非酶胶原交联产物 fAGEs 的积累与腰椎脊柱旁肌肉中肌内脂肪的增加有关。
