Ensrud K E, Black D M, Harris F, Ettinger B, Cummings S R
Department of Medicine, VA Medical Center, Minneapolis, MN 55417, USA.
J Am Geriatr Soc. 1997 Jun;45(6):682-7. doi: 10.1111/j.1532-5415.1997.tb01470.x.
To determine the association between kyphosis (degree of forward curvature of the thoracic spine) and measures of spinal osteoporosis (height loss and vertebral fractures) and chronic back pain and disability in older women.
A cross-sectional study.
Eleven clinical centers in the United States.
A total of 6439 community-dwelling osteoporotic women aged 55-80 enrolled in the Fracture Intervention Trial (FIT), a multicenter clinical trial of alendronate.
Thoracic curvature was measured at baseline using a Debreuner Kyphometer. Height loss was determined by subtracting current height measured with a Harpenden stadiometer from self-reported height at age 25. Vertebral fractures were defined by morphometry and semiquantitative reading of lateral thoracic and lumbar spine radiographs, and chronic back pain and back-related disability were assessed by questionnaire.
After adjustment for age, a 15 degrees increase in kyphosis was associated with losing more than 4 cm of height (OR, 1.88; 95% CI, 1.79-2.03) and having a vertebral fracture (OR, 1.57; 95% CI, 1.46-1.69). Kyphosis was more strongly related to thoracic fractures than to lumbar fractures, and kyphosis was most prominent in women with multiple thoracic wedge fractures. Kyphosis was also associated with upper back pain (OR per 15 degrees increase, 1.62; 95% CI 1.47-1.79) and middle back pain (OR per 15 degrees increase, 1.24; 95% CI 1.12-1.36), but it was not related to lower back pain (OR per 15 degrees increase, 0.98; 95% CI 0.90-1.05). Women with greater degrees of kyphosis were only slightly more likely to report back-related disability (OR per 15 degrees increase, 1.18; 95% CI 1.03-1.35) and poorer health status (OR per 15 degrees increase, 1.19; 95% CI 1.03-1.37).
Older women with greater degrees of kyphosis are likely to have other manifestations of spinal osteoporosis such as height loss and thoracic fractures and to suffer chronic upper and middle back pain. Measurement of kyphosis may be useful in assessing the severity of spinal osteoporosis.
确定老年女性脊柱后凸（胸椎前曲程度）与脊柱骨质疏松测量指标（身高降低和椎体骨折）、慢性背痛及残疾之间的关联。
一项横断面研究。
美国的11个临床中心。
共有6439名年龄在55 - 80岁的社区居住骨质疏松女性参与了骨折干预试验（FIT），这是一项关于阿仑膦酸盐的多中心临床试验。
在基线时使用德布鲁纳后凸计测量胸椎曲度。身高降低通过用哈彭登身高计测量的当前身高减去25岁时自我报告的身高来确定。椎体骨折通过形态测量法以及对胸椎和腰椎侧位X线片的半定量读数来定义，慢性背痛和与背部相关的残疾通过问卷调查进行评估。
在对年龄进行校正后，脊柱后凸增加15度与身高降低超过4厘米（比值比[OR]，1.88；95%置信区间[CI]，1.79 - 2.03）以及椎体骨折（OR，1.57；95% CI，1.46 - 1.69）相关。脊柱后凸与胸椎骨折的相关性比与腰椎骨折更强，并且在患有多个胸椎楔形骨折的女性中脊柱后凸最为明显。脊柱后凸还与上背部疼痛（每增加15度的OR，1.62；95% CI 1.47 - 1.79）和中背部疼痛（每增加15度的OR，1.24；95% CI 1.12 - 1.36）相关，但与下背部疼痛无关（每增加15度的OR，0.98；95% CI 0.90 - 1.05）。脊柱后凸程度较高的女性报告与背部相关残疾（每增加15度的OR，1.18；95% CI 1.03 - 1.35）和健康状况较差（每增加15度的OR，1.19；95% CI 1.03 - 1.37）的可能性仅略高。
脊柱后凸程度较高的老年女性可能有脊柱骨质疏松的其他表现，如身高降低和胸椎骨折，并患有慢性上背部和中背部疼痛。测量脊柱后凸可能有助于评估脊柱骨质疏松的严重程度。
