一项关于脊柱退行性疾病对老年人骨密度影响的纵向研究。

A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly.

作者信息

Jones G, Nguyen T, Sambrook P N, Kelly P J, Eisman J A

机构信息

Garvan Institute of Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, Australia.

出版信息

J Rheumatol. 1995 May;22(5):932-6.

PMID:8587085

Abstract

OBJECTIVE

To describe the relationship between spinal degenerative disease and bone density in the elderly both cross sectionally and longitudinally.

METHODS

Random population based sample of 113 men and 187 women over 60 yrs of age participating in the Dubbo Osteoporosis Epidemiology Study (a longitudinal population based study of fracture risk factors) who had bone density measured on 2 occasions (average interval 2.5 yrs) and spinal radiographs on one occasion (performed according to a standardized approach).

RESULTS

Spinal degenerative disease, of varying severity, was common in this population (osteophytes 69%, disc narrowing 67%, posterior element disease 99%). Scores for osteophytosis, disc narrowing, and posterior element disease (together with age and body mass index) independently explained 43% of the variation in spinal bone density in men (p < 0.00001) and 26% in women (p < 0.00001). The rate of change at the spine increased with increasing severity of osteophytosis in both men (p = 0.03) and women (p = 0.05), but not the other measures, and the total amount of variation explained by these measures was modest. In comparison, severity of spinal degenerative disease had only a modest but significant relationship with femoral neck bone density in both sexes, but not its rate of change. Subjects with any degree of osteophytosis had higher bone density compared to those without osteophytes at both the lumbar spine (men 21% higher, 95% CI 12-31; women 16% higher, 95% CI 9-23) and, to a lesser extent, femoral neck (men 12% higher, 95% CI 4-20; women 6% higher, 95% CI 1-13). Vascular calcification had no relationship with bone density at either spine or hip.

CONCLUSION

Spinal bone density measurement and its sequential followup may be erroneous in the elderly due to concomitant degenerative disease. Bone density at the femoral neck was much less affected by spinal degenerative disease, which suggests that this site may be more efficacious for both monitoring response to treatment and determining fracture risk in the elderly.

摘要

目的

从横断面和纵向角度描述老年人脊柱退行性疾病与骨密度之间的关系。

方法

基于随机抽样，选取113名男性和187名60岁以上的女性参与达博骨质疏松症流行病学研究（一项基于人群的骨折风险因素纵向研究），这些人接受了两次骨密度测量（平均间隔2.5年），并在某一时刻进行了一次脊柱X光检查（按照标准化方法进行）。

结果

不同严重程度的脊柱退行性疾病在该人群中很常见（骨赘形成69%，椎间盘狭窄67%，后部结构疾病99%）。骨赘形成、椎间盘狭窄和后部结构疾病的评分（连同年龄和体重指数）分别独立解释了男性脊柱骨密度变化的43%（p<0.00001）和女性的26%（p<0.00001）。男性（p = 0.03）和女性（p = 0.05）中，脊柱骨密度变化率均随骨赘形成严重程度的增加而升高，但其他测量指标则不然，且这些测量指标所解释的总变化量不大。相比之下，脊柱退行性疾病的严重程度与两性的股骨颈骨密度仅存在适度但显著的关系，与股骨颈骨密度变化率无关。有任何程度骨赘形成的受试者，其腰椎骨密度高于无骨赘者（男性高21%，95%可信区间12 - 31；女性高16%，95%可信区间9 - 23），在股骨颈处也有升高，但程度较小（男性高12%，95%可信区间4 - 20；女性高6%，95%可信区间1 - 13）。血管钙化与脊柱或髋部的骨密度均无关系。