腰椎间盘退变和骨密度的相关性分析

目的通过对临床病例腰椎间盘退变分级、MRI-T1ρ值与相应骨密度(bone mineral density,BMD)的相关性分析,推断腰椎间盘退行性变与原发性骨质疏松的相关性关系。方法 2014年4月-2015年4月我院骨科病例共338例,并对其进行腰椎影像学检查和骨密度检查,测得所有病例的腰椎间盘退变的Pfirrmann分级、椎间盘MRI-T1ρ值及相应骨密度(T值),并行前两者与骨密度的统计学相关性分析,进而分析探讨腰椎间盘退变与相应骨密度的相关性。结果 Pfirrmann腰椎间盘退变MRI分级与相应骨密度存在显著相关关系(r=-0.206,P0.01)。腰椎间盘MRI-T1ρ值与相应骨密度存在显著相关关系(r=0.312,P0.01)。结论腰椎间盘退变与原发性骨质疏松存在显著的相关关系。     

绝经后女性骨密度与腰椎间盘退变的相关性分析

目的:观察绝经后女性腰椎和髋部骨密度与腰椎间盘退变的关系。方法:回顾性统计2017年12月～2018年12月因腰痛在我院脊柱外科门诊及住院的229例绝经后女性患者,记录患者年龄、身高、体重、糖尿病史、高血压病史、饮酒史、吸烟史等,采用双能X线骨密度测量仪检查患者腰椎椎体(L1～L4)骨密度和髋部平均骨密度,记录相应的T值,每例患者同时行腰椎MRI检查。根据骨密度T值≥-1.0为正常,-2.5 T值-1.0为骨量减少,T值≤-2.5诊断为骨质疏松,将患者分为骨质疏松组(n=78)、骨量减少组(n=73)和正常组(n=78)。每个节段腰椎间盘退变程度用Pfirrmann分级系统进行评分,用协方差和Spearman相关性分析来分析腰椎和髋部骨密度与腰椎间盘退变的关系。结果:骨质疏松组、骨量减少组和骨量正常组的年龄分别为67.17±9.99岁、65.66±10.71岁、55.29±12.35岁,骨质疏松组、骨量减少组年龄显著大于骨量正常组(P0.05);骨质疏松组的体重指数小于正常组(23.38±2.37kg/m~2 vs 24.72±2.96kg/m~2,P0.05);其余一般资料各组间无显著性差异(P0.05)。上腰椎(L1、L2)中,骨质疏松组腰椎间盘退变评分均较正常组低(2.24±0.82 vs 2.60±0.95,2.79±0.95 vs3.18±0.94,P0.05),而与骨量减少组比较无显著性差异(P0.05);下腰椎(L3、L4)椎体和髋部不同骨密度组之间椎间盘退变程度无显著性差异(P0.05)。各腰椎椎体骨密度分别与腰椎间盘平均退变程度呈正性相关(L1:r=0.185;L2:r=0.157;L3:r=0.180;L4:r=0.132;L1～L4:r=0.180;均P0.05),髋部骨密度与腰椎间盘退变的严重程度无统计学相关性。结论:绝经后女性腰椎间盘退变的严重程度与腰椎骨密度存在正相关关系,提示绝经后女性腰椎骨密度较高者椎间盘退变可能更严重,有必要进一步做腰椎CT或者MRI检查;股骨颈骨密度检查对骨质疏松诊断更有帮助。     

绝经后女性骨密度与腰椎间盘退变程度的相关性研究

目的探讨绝经后女性骨密度与腰椎间盘退变程度的相关性。方法回顾性研究西南医科大学附属医院2017年1月至2019年12月收治的因慢性腰痛住院的251例绝经后女性患者。收集患者的年龄、绝经年限、体质量指数(body mass index,BMI)。采用双能X线骨密度仪检测患者腰椎(L_(1～4))及髋部平均骨密度,根据骨密度T值将患者分为骨量正常组(n=45)、骨量低下组(n=71)和骨质疏松组(n=135)。同时患者均行腰椎MRI检查,采用Pfirrmann分级系统评估腰椎间盘退变程度(L1/2、L2/3、L3/4、L4/5、L5/S1)。采用Spearman相关性分析骨密度与腰椎间盘退变程度的关系。结果骨质疏松组和骨量低下组的年龄、绝经年限显著大于骨量正常组(P0.05)。骨质疏松组和骨量低下组的BMI明显小于骨量正常组(P0.05)。骨质疏松组和骨量低下组的L1/2、L2/3、L3/4、L1～S1(L1/2～L5/S1的平均值)椎间盘退变评分明显高于骨量正常组(P0.05)。骨质疏松组的L4/5、L5/S1椎间盘退变评分高于骨量正常组(P0.05),骨量低下组与骨量正常组比较差异无统计学意义(P0.05)。相关性分析结果显示,骨密度与BMI呈正相关(P0.05),与年龄、绝经年限、L1/2、L2/3、L3/4、L4/5、L5/S1、L1～S1椎间盘退变评分呈负相关(P0.05)。结论绝经后女性骨密度与BMI呈正相关,与年龄、绝经年限、腰椎间盘退变程度呈负相关。绝经后女性骨密度越低,其腰椎退变程度越严重。     

我国汉族人腰椎骨密度与相邻椎间盘退变的相关性研究

目的研究并探讨腰椎骨密度和相邻椎间盘退变之间的相关关系。方法回顾性选取同时有腰椎磁共振和DXA腰椎骨密度检查的男性人群224例、女性人群288例。Pfirrmann法评估腰椎间盘退变程度,多因素回归统计分析腰椎骨密度与年龄、体重指数以及腰椎间盘退变的相关性。结果男性人群年龄显著小于女性人群(P0.01),而男性人群体重指数大于女性人群(P0.01);男性人群各节段腰椎骨密度均大于女性人群(P0.01),女性人群各节段腰椎间盘退变程度均大于男性人群(P0.01);下腰椎(L3、L4)的腰椎骨密度和腰椎间盘退变程度均比上腰椎高(L1、L2)。男性人群中,下腰椎L4椎体骨密度与相邻的L4/5椎间盘退变程度呈正性相关(Coef.=0.04,P0.05);女性人群中,下腰椎L3和L4椎体骨密度分别与相邻的L3/4、L4/5椎间盘退变程度呈正性相关(Coef.=0.04,P0.01);其余椎体骨密度与相邻椎间盘退变均未见统计学相关性。结论下腰椎椎体骨密度越大,相邻的椎间盘退变越严重。相对较高的腰椎骨密度可能是腰椎间盘退变的危险因素。     

骨质疏松与椎间盘退变相关性的研究进展

骨质疏松症和椎间盘退变性疾病均为骨退行性疾病,临床上两者常可并见于同一病例,二者可能存在相似的发病机制,但骨质疏松和椎间盘退变的内在联系目前没有明确论述。本文就骨质疏松和椎间盘退变两方面的相关性从:骨质疏松对椎间盘营养的影响、炎性因子在椎间盘退变性疾病和骨质疏松症中的作用、雌激素对骨质疏松和椎间盘退变的影响、破骨细胞/破软骨细胞对骨质疏松和椎间盘退变的影响、OPG对骨质疏松和椎间盘的保护作用等几方面做一探讨。最后得出:骨质疏松和椎间盘退变存在一定的相关性和相似的发病机制,骨质疏松这一病理因素可能参与了椎间盘退变的病理进程,从而推测骨质疏松会引起或加速椎间盘的退变。     

不同性别人群椎体骨密度对腰椎间盘退变程度的影响分析

目的探讨男性与女性人群腰椎骨密度(bone mineral density,BMD)对其腰椎间盘退变的影响。方法自2015年1月-2018年1月,共纳入126例老年腰椎间盘突出症人群,按性别分为男性组75例与女性组51例。统计所有患者的椎体BMD值和L_(1-5)腰椎间盘退变Pfirrmann评分情况,并分析男性和女性人群腰椎BMD值与椎间盘退变的相关性。结果 (1)男性组各节段腰椎BMD水平均显著高于女性组,且两组下腰椎段椎体(L_3、L_4)BMD均显著高于上腰椎段椎体(L_1、L_2),差异有统计学意义(P0.05)。(2)男性组各节段腰椎间盘退变程度均低于女性组,且两组下腰椎段椎间盘(L_(3-4)、L_(4-5))退变程度均显著高于上腰椎段(L_(1-2)、L_(2-3)),差异均有统计学意义(P0.05)。(3)男性组L_4BMD水平与腰椎间盘(L_(4-5))退变程度呈显著的负相关关系(P0.05);女性组L_3和L_4BMD水平与腰椎间盘(L_(3-4)、L_(4-5))退变程度呈显著负相关关系(P0.05)。结论无论是男性或女性人群,其下腰椎段椎体BMD与相邻的椎间盘退变程度均呈负相关关系,BMD水平越低则相邻椎间盘退变程度越严重;反之,BMD水平提高,则椎间盘退变有减缓趋势。     

去卵巢致肾虚的腰椎间盘退变模型的实验研究

目的:观察去前肢卵巢对大鼠腰椎间盘和椎体骨密度的影响,建立大鼠肾虚型腰椎间盘退变模型,探讨椎间盘退变的内在机制、椎间盘退变和骨质疏松之间的关系。方法:选择1月龄雌性SD大鼠30只,随机分为正常对照组、腰椎间盘退变组、肾虚型腰椎间盘退变组(复合模型组),每组10只。腰椎间盘退变组大鼠去除双前肢,肾虚型腰椎间盘退变组大鼠在去除双前肢3个月后,再去除双卵巢。8个月后,通过Micro-CT扫描观察椎体骨密度,藏红O-快绿染色法观测椎间盘组织形态学改变,免疫组织化学法观察Ⅱ、Ⅹ胶原在椎间盘中的蛋白表达,实时荧光定量聚合酶链式反应(real-time polymerase chain reaction,RT-PCR)法检测细胞外基质相关基因的表达,以评价去除双前肢和双卵巢对椎间盘退变和椎体骨密度的影响。结果:Micro-CT扫描发现,肾虚型腰椎间盘退变组动物椎体骨质疏松明显;藏红O-快绿染色法显示椎间隙变窄,肾虚型腰椎间盘退变组椎间盘组织退变明显,软骨板发育不全;免疫组织化学染色显示肾虚型腰椎间盘退变组相对于正常对照组,椎间盘内Ⅹ型胶原表达增加,Ⅱ型胶原表达降低;RT-PCR分析发现,腰椎间盘退变组和肾虚型腰椎间盘退变组Ⅱ型胶原(typeⅡcollagen,Col2a1)基因的表达较正常对照组低,3组比较差异有统计学意义(P=0.000,P=0.000﹚;腰椎间盘退变组和肾虚型腰椎间盘退变组聚集蛋白聚糖(aggrecan-1,Agc1)基因的表达较正常对照组低,差异有统计学意义(P=0.000,P=0.000﹚;腰椎间盘退变组和肾虚型腰椎间盘退变组Ⅹ型胶原(type X collagen,Col10al)基因的表达较正常对照组高,差异无统计学意义;肾虚型腰椎间盘退变组基质金属蛋白酶-13(matrix metalloproteinase 13,MMP-13)基因的表达较正常对照组和腰椎间盘退变组高,3组比较差异有统计学意义(P=0.000,P=0.000);腰椎间盘退变组和肾虚型腰椎间盘退变组聚集蛋白聚糖降解酶2(aggrecanase-2,ADAMTS-5)基因的表达较正常对照组高,差异有统计学意义(P=0.006,P=0.008)。结论:采用去双前肢和去卵巢的方式建立的大鼠腰椎间盘退变模型,出现了肾虚"骨象"———骨质疏松,并在组织形态学、分子细胞生物学等方面的表现与临床肾虚型腰椎间盘退变更加相似。     

退行性腰椎侧凸与骨质疏松症的相关性分析

目的:研究成年人腰椎退变性侧凸与骨质疏松的相互关系。方法:自2012年3月至2016年6月,采用回顾性分析方法对53例腰椎退变性侧凸患者进行腰椎退变性侧凸与骨质疏松症相关性研究,男11例,女42例,年龄63～76岁,平均69岁,匹配同期就诊的非腰椎侧凸患者53例,其中腰椎间盘突出症33例,腰椎管狭窄症13例,腰椎滑脱症7例,男16例,女37例,年龄59～74岁,平均68.5岁。53例患者均拍摄腰椎正侧位X线片及腰椎MRI确诊,测量并记录腰椎侧凸Cobb角。运用双能X射线吸收法对所有患者进行骨密度检查,记录腰椎(L_2-L_4)、股骨颈、股骨粗隆、Ward三角部位T值。采用Linear regression研究腰椎侧凸角度与骨质疏松的相关性。结果:腰椎侧凸组与非腰椎侧凸组两者骨密度T值差异有统计学意义,腰椎退变性侧凸患者骨密度T值(-2.56±0.65)明显高于非腰椎侧凸组(-1.39±0.77)(P0.05),腰椎侧凸患者腰椎(L_2-L_4)、股骨颈、股骨粗隆、Ward三角部位的T值与侧凸Cobb角无明显相关性。结论:骨质疏松是发生腰椎退变性侧凸的危险因素,但侧凸程度与骨质疏松程度无明显相关性。     

腰椎间盘突出所致坐骨神经痛发病机制

目前研究认为腰椎间盘突出导致坐骨神经痛发病机制为突出椎间盘组织对邻近神经根造成机械性压迫损害,主要包括牵张和压迫两种机制;退变、突出的椎间盘组织是一种发生炎性改变的组织,表达多种炎症细胞因子,这些细胞因子刺激邻近神经根,诱发坐骨神经疼痛性改变;突出椎间盘组织还可诱发自身免疫反应,临床疼痛程度与自身免疫反应程度密切相关;退变椎间盘组织中出现多种神经生长因子表达和神经纤维长入,神经生长因子促进神经纤维生长,神经纤维在诱发坐骨神经疼痛传导中具有重要作用;患者心理和社会因素与坐骨神经痛之间也存在相关性。腰椎间盘突出所致坐骨神经痛发病机制的研究,有助于指导临床合理治疗。     

肥胖及骨密度与腰椎间盘退变程度的相关性研究

目的 分析不同体质量指数(body mass index,BMI)的腰椎间盘突出症患者骨密度(bone mineral density,BMD)、腰椎间盘退变程度差异,并探讨BMD与腰椎间盘退变程度的相关性.方法 回顾2017年1月～2020年1月因腰腿痛于本院脊柱骨科门诊就诊的137例腰椎间盘突出症患者临床资料.基于体质量指数,分为正常组(18.50.05);三组下腰椎椎体(L3、L4)BMD水平、下腰椎椎间盘(L3-4、L4-5)退变程度比较,差异有统计学意义(P<0.05),其中,肥胖组L3与L4 BMD水平、L3-4与L4-5段椎间盘退变程度均明显高于其他两组(P<0.05),超重组L3与L4 BMD水平、L3-4与L4-5段椎间盘退变程度明显高于正常组(P<0.05).Pearson相关性分析显示,L3 BMD水平与L3-4椎间盘退变程度呈负相关(r=-0.547,P<0.05);L4 BMD水平与L4-5椎间盘退变程度呈负相关(r=-0.741,P<0.05).结论 BMI与腰椎BMD、腰椎间盘退变程度存在关联;对于腰椎间盘突出症合并肥胖患者,更易发生下腰椎椎间盘退变,下腰椎椎体BMD与相邻椎间盘退变程度呈负相关,椎间盘退变程度随BMD水平升高有减缓趋势.     

骨质疏松与腰椎退行性变的相关性分析

目的探讨骨质疏松与腰椎退行性变之间的内在联系,为临床预测疾病的预后、并进而采取相应的措施阻止或延缓疾病的发展进程提供客观的临床依据。方法本研究采用随机对照研究方法,随机抽取在我院住院患者180例,测试骨密度,据此分为3组:骨量正常组、骨量减少组及骨质疏松组,分别拍摄腰椎正侧位X-ray片,测量骨赘积分、椎间盘高度及椎体形变。结果 Nathan积分比较,骨质疏松组与骨量减少组及骨量正常组间有显著性差异(P0.05),骨量减少组及骨量正常组无显著性差异(P0.05);各组之间对应节段椎间盘高度差异有显著性意义(P0.05),其中,骨质疏松组的椎间盘高度明显小于骨量减少组及骨量正常组;椎体形变在低骨量组与骨量正常组之间差异不明显(P0.05),而骨质疏松组的椎体其畸形变的程度与骨量减少组及骨量正常组差异有显著性意义(P0.05),且畸形变多发生在L1、L4、L5,以ha/hp减少多见。结论骨质疏松组的腰椎退变程度最重,骨量减少组的腰椎退变程度较轻,骨量正常组的腰椎退变程度最轻,提示骨质疏松与腰椎退变呈正相关,骨质疏松可加速腰椎退变的进程。     

绝经后妇女身高缩短程度与骨质疏松发生的关系研究

目的探讨绝经后妇女身高缩短程度与骨质疏松发生的关系。方法随机选择绝经后妇女进行健康问卷调查,包括现在、年轻时身高;用双能X线骨密度仪测定腰椎、髋部骨密度,分为骨质疏松组和无骨质疏松组;用SPSS 20.0统计软件统计分析。结果共筛选入组263例,骨质疏松组160例、无骨质疏松组103名:(1)两组资料的一般比较:年龄、身高缩短(H/cm)、BMI、膝关节炎、腰椎间盘突出等因素差异具有统计学意义(P0.05),身高、体重、绝经年龄等因素无统计学意义(P0.05);(2)各因素与骨密度的相关性分析:身高缩短、关节炎等因素与腰椎、髋部骨密度呈负相关,腰椎间盘突出与腰椎骨密度呈负相关、与髋部骨密度无相关性;以身高缩短作为因变量,骨质疏松、关节炎、腰椎间盘突出为变量进行多重线性回归分析:y=0.027+0.008×骨质疏松+0.009×膝关节炎+0.003×腰椎间盘突出,标准回归系数依次为0.183、0.171、0.063,骨质疏松对身高缩短程度影响最大,其次是膝关节炎;(3)263例不同身高缩短的分布情况:身高缩短H3 cm,无骨质疏松和有骨质疏松占各本组的31.1%和50.0%;从箱式图可以知道三组身高缩短均值从高到低依次是:重度骨质疏松、轻度骨质疏松、无骨质疏松。结论绝经后妇女身高缩短与骨密度呈负相关,骨质疏松能够影响身高缩短,身高缩短越大骨质疏松越严重。身高缩短3 cm时提示可能发生骨质疏松。     

腰椎间盘突出症与腰椎骨密度的相关性研究

目的 研究腰椎间盘突出症(lambar disc herniation,LDH)与骨质疏松(osteoporosis,OP)的相关性,探讨腰椎间盘突出症对骨密度的影响.方法 选取腰椎间盘突出症组患者82例,对照组健康体检人群41例,利用定量CT(quantitative computed tomography,QCT)测定其骨密度(bone mineral density,BMD),分析比较两组的骨密度值.并对腰椎间盘突出症组患者病程:≤1年与＞1年,腹肌肌力≤3级与≥4级骨密度值变化进行比较分析.结果 腰椎间盘突出症组患者的骨密度值较对照组低,骨量减少者在腰椎间盘突出症组中的构成比较对照组高,但差异均无统计学意义(P>0.05).其病程、腹肌肌力对腰椎间盘突出症组患者骨密度值变化的影响无统计学差异(P>0.05).结论 腰椎间盘突出症对骨密度有一定的影响,但两者的关系不显著,腰椎间盘突出症并非骨质疏松的独立影响因素.     

退变性腰椎侧凸形成和发展的相关因素分析

目的 探讨退变性腰椎侧凸患者椎问盘的不对称指数、腰椎间盘退变程度以及骨密度降低对侧凸角度的影响.方法 采用回顾性研究的方法,选取2002年1月至2010年8月,共96例退变性腰椎侧凸患者为研究对象(侧凸组);2002年1月至2010年8月确诊为腰椎管狭窄症并且资料齐全的患者96例为对照组;两组间性别、年龄、体质量指数匹配.侧凸组:在腰椎正位X线片上测量凸凹侧顶椎间盘及其上下椎间盘的高度和顶椎及其上下椎体的高度,利用Adobe Photoshop 6.0软件,测量MRI图像T2WI顶椎及其上下椎间盘内髓核与脑脊液的相对信号强度.对照组:取2～3、L3-4、L4-5这3个椎间盘为研究对象测定上述指标.应用双能X线吸收法测定两组患者腰椎(L2-4)及股骨颈、股骨粗隆和Ward's三角的T值.结果 侧凸组凸侧椎间盘高度和为(40±7)mm高于凹侧的(28±7)mm(P<0.01),凸侧椎体高度和为(76±12)mm高于凹侧的(72±10)mm(P=0.016):两组之间的椎间盘退变程度差异有统计学差异(P=0.003);两组之间骨密度T值的平均值和骨质疏松的发生率差异有统计学意义(均P<0.01).通过多元线性回归分析结果 显示患者椎间盘的不对称指数、椎间盘的退变程度、骨密度T值影响退变性腰椎侧凸角度.结论 退变性腰椎侧凸常伴有凸凹两侧椎间盘高度以及椎体高度不对称.侧凸角度与椎间盘的不对称指数、椎间盘的退变程度呈正相关,与骨密度值T值呈负相关.

Abstract：

Objectives To investigate the correlation between scoliosis angle and the asymmetric index of degenerative lumbar scoliosis, the degree of intervertebral disc degeneration, decreased bone density. Methods As a retrospectively study, a total of 96 patients with degenerative lumbar scoliosis were retrospectively enrolled from January 2002 to August 2010 as scoliosis group, meanwhile % patients with lumbar spinal stenosis matched in gender, age and body mass index (BMI) were selected as control group.All patients were studied with plain radiographs, MRI and dual energy X-ray absorptiometry at presentation. Radiographic measurements include Cobb angle, the height of the convex and concave side of the apical disc and the contiguous disc superiorly and inferiorly, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly in scoliosis group, the height of L2-3, L3-4, L4-5 discs and the height of L2-4 vertebral body in control group. The average relative signal intensity of lumbar intervertebral disc and cerebrospinal fluid in T2WI sagittal image was measured in apex intervertebral disc and adjacent discs by Adobe Photoshop 6.0 in scoliosis group, which was measured in L2-3, L3-4, L4-5 disc in control group. The bone density of lumbar, femoral neck, trochanter, and Ward's triangle regions were measured with dual-energy X-ray absorptiometry. Results The intervertebral disc height in convex side was greater than the height in the concave side [(40 ± 7) mm vs. (28 ± 7) mm, P < 0. 01] , the vertebral body height in convex side was greater than the height in the concave side [(76 ± 12) mm vs. (72 ± 10) mm, P =0.016] in scoliosis group. There was significant statistically difference in the degenerative degree of intervertebral discs between two groups (P = 0. 003). There was significant statistically difference of the average T-value and the rate of osteoporosis between two groups (P < 0. 01). Multiple linear regression analysis showed that the asymmetric disc index, the degenerative degree of intervertebral disc and osteoporosis were the predominant correlative factors, which affected the development of degenerative lumbar scoliosis. Conclusions Degenerative lumbar scoliosis is always accompanied by the height asymmetry of intervertebral discs and vertebral body from convex and concavity sides. There is positive correlation between the angle of scoliosis and the asymmetric disc index, the degeneration of intervertebral disc, and negative correlation between the angle of scoliosis and the bone density (T-value).     

不同程度的骨质疏松与腰椎退行性变的临床分析

目的 探讨腰椎各期退行性变与不同程度骨质疏松的.收集本院122例腰椎不同时期退行性变的病例，将其CT、MRI和X线平片进行临床分析。结果 122例腰椎退变与骨质疏松程度的构成比中，除椎间盘膨出病例外，其余椎间盘突出，椎间盘脱出及椎管狭窄的构成比随骨质疏松程度加重而高。结论 骨质疏松严重程度与脊椎退行性病变临床表现密切相关，提示临床上治疗腰椎退行变的同时，应积极治疗骨质疏松，才能有效的提高临床疗效。     

132例原发性骨质疏松症女性身高变化与腰椎骨密度相关性分析

目的分析骨质疏松症女性患者身高变化与腰椎骨密度的相关性。方法通过测量132例女性骨质疏松症患者的现身高,回顾25~30岁时身高,计算身高变矮程度,同时检测患者的BMD进行相关性分析,并描绘散点图。结果随着患者腰椎骨密度降低,患者较年轻时身高变矮的程度在逐渐增加;随着年龄的增加,患者的身高逐渐变矮,采用SPSS11.5 Spearman相关系数的方法计算,得出P0.05,不具有统计学差异,即本组研究中选取的132例患者的身高变化与患者腰椎1-4的BMD之间无相关联性。结论天津地区132例女性骨质疏松症患者的身高变化与腰椎BMD之间无明显相关性。人体身高变化的影响因素较多,同时存在测量的误差,在观察身高与BMD相关性分析时应分别测量躯干或肢体的长度,以提高准确性。     

The distal radial fracture in elderly women and the bone mineral density of the lumbar spine and hip

The incidence of distal radial fractures in elderly women is high and is associated with osteoporosis and hip fracture. Osteoporosis can be detected by measuring the bone mineral density (BMD) of the lumbar spine or hip with dual energy X-ray absorptiometry. Low BMD of the lumbar spine or hip is a strong predictor for future vertebral deformities and hip fractures. At present, elderly women with a distal radial fracture are not investigated for osteoporosis on a routine basis. The BMD of the lumbar spine and hip were assessed in 94 women (mean age, 69 years) with a distal radial fracture. A low BMD was found in 85% of the patients, and osteoporosis was diagnosed in 51%. The mean BMD decreased by 0.04 SD per year and there was a significant relationship between post-menopausal status and decreased BMD of the hip. The BMD in patients treated with bisphosphonate medication increased significantly in 1 year. As more than half of the elderly women with a distal radial fracture have osteoporotic BMD values for the lumbar spine or hip, it is our opinion that such patients should be screened for osteoporosis.     

Disc degeneration contributes to the denser bone in the subendplate but not in the vertebral body in patients with lumbar spinal stenosis or disc herniation

BACKGROUND CONTEXTIt is commonly believed that decreased bone quality would lead to endplate degeneration and arthritic changes in the facet joints, and thus accelerated disc degeneration (DD). However, some more detailed studies of vertebral bone structure have found that bone mineral density (BMD) in the vertebral body is increased rather than decreased in moderate or greater disc degeneration. The relationship between BMD and DD still needs further study. MRI-based vertebral bone quality scores have been shown to be effective in reflecting BMD, rendering a new way to evaluate the changes of vertebral body bone with DD using MRI alone.PURPOSETo evaluate MRI-based vertebral bone quality and Pfirrmann grades in patients with lumbar spinal stenosis or disc herniation, and to identify if DD is associated with denser bone around the endplate.STUDY DESIGN/SETTINGA single-center, retrospective cohort study.PATIENT SAMPLEA total of 130 patients with lumbar disc herniation and lumbar spinal stenosis from January 2019 to November 2020 who had a complete dual-energy X-ray absorptiometry scan and noncontrast lumbosacral spine MRI data.OUTCOME MEASURESThe vertebral bone quality score (VBQ) and sub-endplate bone quality score (EBQ) was calculated as a ratio of the signal intensity of the vertebral bodies and sub-endplate regions to the signal intensity of the cerebrospinal fluid at L3 on the mid-sagittal T1-weighted MRI images, respectively. The Pfirrmann grades of the lumbar discs were assessed as well.METHODSThe age, gender, body mass index, and T-score of the lumbar spine of the patients were collected. The degeneration grades of the lumbar discs were evaluated according to the Pfirrmann classification. VBQ and EBQ were measured through T1-weighted lumbar MRI. The VBQ and EBQ scores were compared between cranial and caudal sides. The correlation between MRI-based bone quality and DD was calculated. A linear regression model was used to examine the association between DD and adjacent EBQ and VBQ.RESULTSThis study included 569 lumbar segments from 130 inpatients. Cranial and caudal EBQ decreased with the increase of the Pfirrmann grade. The discs with Pfirrmann grade 5 had significantly lower caudal EBQ than the discs with Pfirrmann grades 2, 3, and 4. In the osteoporosis patients, the Pfirrmann grades negatively correlated both with the cranial EBQ and caudal EBQ. Pfirrmann grade greater than 4 was an independent contributor to the cranial EBQ, whereas greater than 3 was an independent contributor to the caudal EBQ.CONCLUSIONSDisc degeneration grades correlated with the EBQ but not with the VBQ. In patients with lumbar spinal stenosis or disc herniation, DD contributes to the denser bone in the sub-endplate, but not in the whole vertebral body.