Sone T, Tomomitsu T, Miyake M, Takeda N, Fukunaga M
Department of Nuclear Medicine, Kawasaki Medical School, Kurashiki, Japan.
Osteoporos Int. 1997;7(2):113-8. doi: 10.1007/BF01623685.
Because no gold standard for the definition of vertebral fracture exists, there has been controversy about whether mild vertebral deformities are truly fractures or simply normal variation in vertebral size and shape. The aim of this study was to assess the associations of mild variations of vertebral height ratios to definite vertebral fractures. In 479 Japanese women (aged 53.9 +/- 9.1 years) who visited our institute for a medical checkup, we performed lateral lumbar radiographs and morphometric parameters were derived by measuring the anterior (Ha), middle (Hm) and posterior (Hp) height of each vertebral body from T12 to L4. Vertebral height ratios, Ha/Hp, Hm/Hp or Hp/Hp' of adjacent vertebrae that were more than 3 SD different from vertebra-specific means of normative data were considered to indicate fractures. Forty-five women were diagnosed with at least one fracture. After excluding the subjects with vertebral fracture, we examined the associations of the variations in vertebral height ratios with age, anthropometric parameters and lumbar bone mineral density (BMD) measured by dual-energy X-ray absorptiometry. Vertebral height ratios, especially Hm/Hp in postmenopausal women, tended to decrease with age and were positively associated with BMD. No significant correlation was observed between anthropometric parameters and vertebral height ratios. Aged-related decrease in vertebral height ratios (Ha/Hp and Hm/Hp, each averaged from T12 to L4) was significant even after the correction for BMD. Mean values of height ratios of non-fractured vertebrae adjusted for age and BMD were significantly lower in postmenopausal women with vertebral fracture than in those without vertebral fracture. Logistic regression analysis showed that BMD and height ratios of non-fractured vertebrae were independent predictors of vertebral fracture risk. The results suggest that older women, and women with at least one obvious (3 SD) fracture, tend to have mild deformities which do not qualify using the 3 SD definition. These mild deformities may represent real consequences of osteoporosis, because they are more pronounced among women with obvious fracture.
由于目前尚无脊椎骨折定义的金标准，因此对于轻度椎体畸形究竟是真正的骨折还是仅仅是椎体大小和形状的正常变异一直存在争议。本研究的目的是评估椎体高度比值的轻度变化与明确的椎体骨折之间的关联。在479名到我院进行体检的日本女性（年龄53.9±9.1岁）中，我们拍摄了腰椎侧位X线片，并通过测量T12至L4每个椎体的前部（Ha）、中部（Hm）和后部（Hp）高度得出形态学参数。相邻椎体的椎体高度比值，即Ha/Hp、Hm/Hp或Hp/Hp'，与特定椎体的正常数据均值相差超过3个标准差，则被认为提示骨折。45名女性被诊断至少有一处骨折。在排除椎体骨折患者后，我们研究了椎体高度比值变化与年龄、人体测量学参数以及通过双能X线吸收法测量的腰椎骨密度（BMD）之间的关联。椎体高度比值，尤其是绝经后女性的Hm/Hp，往往随年龄增长而降低，并与骨密度呈正相关。人体测量学参数与椎体高度比值之间未观察到显著相关性。即使在校正骨密度后，椎体高度比值（从T12至L4平均得出的Ha/Hp和Hm/Hp）与年龄相关的下降仍很显著。经年龄和骨密度校正后的无骨折椎体高度比值的平均值在有椎体骨折的绝经后女性中显著低于无椎体骨折的女性。逻辑回归分析表明，骨密度和无骨折椎体的高度比值是椎体骨折风险的独立预测因素。结果表明，老年女性以及至少有一处明显（3个标准差）骨折的女性，往往存在不符合3个标准差定义的轻度畸形。这些轻度畸形可能代表骨质疏松症的实际后果，因为它们在有明显骨折的女性中更为明显。
