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1.
G. Leidig-Bruckner B. Limberg D. Felsenberg T. Bruckner S. Holder A. Kather J. Miksch C. Wüster R. Ziegler C. Scheidt-Nave 《Osteoporosis international》2000,11(2):102-119
Morphometric methods have been developed for standardized assessment of vertebral deformities in clinical and epidemiologic
studies of spinal osteoporosis. However, vertebral deformity may be caused by a variety of other conditions. To examine the
validity of morphometrically assessed vertebral deformities as an index of osteoporotic vertebral fractures, we developed
an algorithm for radiological differential classification (RDC) based on a combination of quantitative and qualitative assessment
of lateral spinal radiographs. Radiographs were obtained in a population of 50- to 80-year-old German women (n= 283) and men (n = 297) surveyed in the context of the European Vertebral Osteoporosis Study (EVOS). Morphometric methods (Eastell 3 SD and
4 SD criteria, McCloskey) were validated against RDC and against bone mineral density (BMD) at the femur and the lumbar spine.
According to RDC 36 persons (6.2%) had at least one osteoporotic vertebral fracture; among 516 (88.9%) nonosteoporotics 154
had severe spondylosis, 132 had other spinal disease and 219 had normal findings; 14 persons (2.4%) could not be unequivocally
classified. The prevalence of morphometrically assessed vertebral deformities ranged from 7.3% to 19.2% in women and from
3.5% to 16.6% in men, depending on the stringency of the morphometric criteria. The agreement between RDC and morphometric
methods was poor. In men, 62–86% of cases with vertebral deformities were classified as nonosteoporotic (severe spondylosis
or other spinal disease) by RDC, compared with 31–68% in women. Among these, most had wedge deformities of the thoracic spine.
On the other hand, up to 80% of osteoporotic vertebral fractures in men and up to 48% in women were missed by morphometry,
in particular endplate fractures at the lumbar spine. In the group with osteoporotic vertebral fractures by RDC the proportion
of persons with osteoporosis according to the WHO criteria (T-score <−2.5 SD) was 90.0% in women and 86.6% in men, compared with 67.9–85.0% in women and 20.8–50.0% in men with vertebral
deformities by various methods. Although vertebral deformities by most definitions were significantly and inversely related
to BMD as a continuous variable in both sexes [OR; 95% CI ranged between (1.70; 1.07–2.70) and (3.69; 1.33–10.25)], a much
stronger association existed between BMD and osteoporotic fractures defined by RDC [OR; 95% CI between (4.85; 2.30–10.24)
and (15.40; 4.65–51.02)]. In the nonosteoporotic group individuals with severe spondylosis had significantly higher BMD values
at the femoral neck (p <0.01) and lumbar spine (p <0.0004) compared with the normal group. On the basis of internal (RDC) and external (BMD) validation, we conclude that assessment
of vertebral osteoporotic fracture by quantitative methods alone will result in considerable misclassification, especially
in men. Criteria for differential diagnosis as used within RDC can be helpful for a standardized subclassification of vertebral
deformities in studies of spinal osteoporosis.
Received: 5 February 1999 / Accepted: 24 June 1999 相似文献
2.
Vertebral wedge angle is greater in older men than in women of similar age, and increases with age in men. Wedge angle may
depend less on bone size than other methods (for example, height ratios), and thus could be more effective at identifying
wedge deformities. We aimed to compare mean wedge angle measured by morphometric X-ray absorptiometry (MXA) in young men and
women, to assess the effect of age on wedge angle in women, and to compare wedge angle and anterior–posterior (ha/hp) height
ratios for the identification of vertebral deformities. Mean wedge angle was similar in normal men (n= 46) and women (n= 106) ages 22–50 years, and did not change significantly with age in normal women ages 22–83 years (n= 222). MXA reference intervals for ha/hp ratios (trimmed mean minus 3.0 SD) and wedge angle (trimmed mean + 3.0, 2.5 and
2.0 SD) were used to identify vertebral wedge deformities in 83 women with osteoporosis, ages 49– 87 years. For agreement
with semiquantitative assessment of radiographs (SQ), kappa (κ) = 0.76 for wedge angle mean plus 2.0 SD, and 0.74 for ha/hp
height ratio mean minus 3.0 SD. Sensitivity was marginally better for wedge angle plus 2.0 SD than for ha/hp when all SQ grades
of deformity were included, but there was no difference between methods for detection of moderate to severe deformities (grades
2 to 3). Diagnostic values for the two approaches were broadly similar. The results of this analysis do not provide strong
evidence for the preferential use of the wedge angle approach.
Received: 2 August 2000 / Accepted: 23 May 2001 相似文献
3.
E. M. C. Lau J. Woo H. Chan M. K. F. Chan J. Griffith Y. H. Chan P. C. Leung 《Calcified tissue international》1998,63(1):1-4
The following health consequences of vertebral deformity in Hong Kong elderly Chinese men and women were studied: the prevalence
of back pain, disability due to back pain, and low morale. Lateral X-ray films were taken of the thoracic and lumbar spine
of 796 community-dwelling Chinese subjects (396 men, 400 women) (aged 70–79). Subjects with one or more definitely deformed
vertebra (reduction in vertebral height 3 SD or more below the mean) were classified as definite cases, those with one or
more mildly deformed vertebra (reduction in vertebral height 2–2.99 SD below the mean) as mild cases, and the rest as controls.
The prevalence and consequences of back pain were measured by a standardized questionnaire, and morale was measured by the
Geriatric Morale Score. The relative risk (RR) and 95% confidence interval (CI) of having back pain and being depressed were
calculated by logistic regression. Classifications included 16% of men and 30% of women as definite cases, 37% of men and
35% of women as mild cases, and 47% of men and 35% of women as controls. The relative risk (RR) of back pain was 2.3 (95%
CI 1.4–3.9) (P < 0.05) in women with definite deformity and 1.5 (95% CI 0.9–2.5) (P > 0.05) in women with mild deformity, as compared with controls. Sixty-four percent of all men had back pain. This prevalence
was much higher than figures obtained in a previous survey on low back pain. The prevalence of back pain did not differ by
deformity status, but more men with vertebral deformity were on analgesic. There was no significant association between disability
due to back pain and vertebral deformity in women. The RR for having a low morale score (of 5 and below) was 2.3 (95% CI 1.3–4.1)
(P < 0.05) in women with mild deformity; men with vertebral deformity did not have a low morale. It was concluded that vertebral
deformity was associated with significant back pain and psychological morbidity in elderly Chinese women. Although men with
vertebral deformity did not report more back pain, more were on analgesics than controls.
Received: 2 July 1997 / Accepted: 8 January 1998 相似文献
4.
Prevalent Vertebral Deformity Predicts Incident Hip though not distal Forearm Fracture: Results from the European Prospective Osteoporosis Study 总被引:5,自引:5,他引:5
A. A. Ismail W. Cockerill C. Cooper J. D. Finn K. Abendroth G. Parisi D. Banzer L. I. Benevolenskaya A. K. Bhalla J. Bruges Armas J. B. Cannata P. D. Delmas J. Dequeker G. Dilsen R. Eastell O. Ershova J. A. Falch B. Felsch S. Havelka K. Hoszowski I. Jajic U. Kragl O. Johnell A. Lopez Vaz R. Lorenc G. Lyritis F. Marchand P. Masaryk C. Matthis T. Miazgowski H. A. P. Pols G. Poor A. Rapado H. H. Raspe D. M. Reid W. Reisinger J. Janott C. Scheidt-Nave J Stepan C. Todd K. Weber A. D. Woolf G. Ambrecht W. Gowin D. Felsenberg M. Lunt J. A. Kanis J. Reeve A. J. Silman T. W. O’Neill 《Osteoporosis international》2001,12(2):85-90
The presence of a vertebral deformity increases the risk of subsequent spinal deformities. The aim of this analysis was to
determine whether the presence of vertebral deformity predicts incident hip and other limb fractures. Six thousand three hundred
and forty-four men and 6788 women aged 50 years and over were recruited from population registers in 31 European centers and
followed prospectively for a median of 3 years. All subjects had radiographs performed at baseline and the presence of vertebral
deformity was assessed using established morphometric methods. Incident limb fractures which occurred during the follow- up
period were ascertained by annual postal questionnaire and confirmed by radiographs, review of medical records and personal
interview. During a total of 40 348 person-years of follow-up, 138 men and 391 women sustained a limb fracture. Amongst the
women, after adjustment for age, prevalent vertebral deformity was a strong predictor of incident hip fracture, (rate ratio
(RR) = 4.5; 95% CI 2.1–9.4) and a weak predictor of ‘other’ limb fractures (RR = 1.6; 95% CI 1.1–2.4), though not distal forearm
fracture (RR = 1.0; 95% CI 0.6–1.6). The predictive risk increased with increasing number of prevalent deformities, particularly
for subsequent hip fracture: for two or more deformities, RR = 7.2 (95% CI 3.0–17.3). Amongst men, vertebral deformity was
not associated with an increased risk of incident limb fracture though there was a nonsignificant trend toward an increased
risk of hip fracture with increasing number of deformities. In summary, prevalent radiographic vertebral deformities in women
are a strong predictor of hip fracture, and to a lesser extent humerus and ‘other’ limb fractures; however, they do not predict
distal forearm fractures.
Received: 23 February 2000 / Accepted: 11 August 2000 相似文献
5.
A. A. Ismail T. W. O'Neill C. Cooper J. D. Finn A. K. Bhalla J. B. Cannata P. Delmas J. A. Falch B. Felsch K. Hoszowski O. Johnell J. B. Diaz-Lopez A. Lopes Vaz F. Marchand H. Raspe D. M. Reid C. Todd K. Weber A. Woolf J. Reeve A. J. Silman 《Osteoporosis international》1998,8(3):291-297
Clinically apparent vertebral deformities are associated with reduced survival. The majority of subjects with radiographic
vertebral deformity do not, however, come to medical attention. The aim of this study was to determine the association between
radiographic vertebral deformity and subsequent mortality. The subjects who took part in the analysis were recruited for participation
in a multicentre population-based survey of vertebral osteoporosis in Europe. Men and women aged 50 years and over were invited
to attend for an interviewer-administered questionnaire and lateral spinal radiographs. Radiographs were evaluated morphometrically
and vertebral deformity defined according to established criteria. The participants have been followed by annual postal questionnaire
– the European Prospective Osteoporosis Study (EPOS). Information concerning the vital status of participants was available
from 6480 subjects, aged 50–79 years, from 14 of the participating centres. One hundred and eighty-nine deaths (56 women and
133 men) occurred during a total of 14 380 person-years of follow-up (median 2.3 years). In women, after age adjustment, there
was a modest excess mortality in those with, compared with those without, vertebral deformity: rate ratio (RR) = 1.9 (95%
confidence interval (CI) 1.0,3.4). In men, the excess risk was smaller and non-significant RR = 1.3 (95% CI 0.9,2.0). After
further adjusting for smoking, alcohol consumption, previous hip fracture, general health, body mass index and steroid use,
the excess risk was reduced and non-significant in both sexes: women, RR = 1.6 (95% CI 0.9,3.0); men RR = 1.2 (95% CI 0.7,1.8).
Radiographic vertebral deformity is associated with a modest excess mortality, particularly in women. Part of this excess
can be explained by an association with other adverse health and lifestyle factors linked to mortality.
Received: 12 June 1997 / Accepted: 6 November 1997 相似文献
6.
Prevalence of Vertebral Deformity and its Associations with Physical Impairment among Japanese Women: The Hizen-Oshima Study 总被引:4,自引:0,他引:4
H. Jinbayashi K. Aoyagi P. D. Ross M. Ito H. Shindo T. Takemoto 《Osteoporosis international》2002,13(9):723-730
Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment,
but the clinical significance of vertebral deformities remains uncertain. We examined the prevalence of vertebral deformity
and associations of vertebral deformities and other characteristics with physical functioning among 584 Japanese women ages
40 to 89 years. Lateral spine radiographs were obtained and radiographic vertebral deformities were assessed by quantitative
morphometry, defined as vertebral heights more than 3 SD below the normal mean. A self-administered questionnaire was used
to survey participants about difficulty in performing selected basic and instrumental activities of daily living (ADL). Overall,
15% of women had at least one vertebral deformity, and 8% had 2 or more. The prevalence of vertebral deformities increased
progressively with age. Half of women ages 80 and over had vertebral deformities. Impaired function was defined as difficulty
performing 3 or more ADLs. After adjusting for age, the odds of impaired function were increased by 1.4 times (95% CI: 0.7,
2.9) in women with a single vertebral deformity, and 3.1 times (1.4, 6.8) in those with two or more deformities. Additional
adjustment for number of painful joints, number of comorbidities, body mass index, and back pain did not materially alter
these findings. In conclusion, women with multiple vertebral deformities had significantly greater impaired function. The
association was independent of age, back pain and the number of painful joints, suggesting that deformities may impair function
even when back pain is not present.
Received: 29 October 2001 / Accepted: 11 April 2002 相似文献
7.
A. C. Scane R. M. Francis A. M. Sutcliffe M. J. D. Francis D. J. Rawlings C. L. Chapple 《Osteoporosis international》1999,9(1):91-97
To investigate the pathogenesis and sequelae of symptomatic vertebral fractures (VF) in men, we have performed a case–control
study, comparing 91 men with VF (median age 64 years, range 27–79 years) with 91 age-matched control subjects. Medical history,
clinical examination and investigations were performed in all patients and control subjects, to identify potential causes
of secondary osteoporosis, together with bone mineral density (BMD) measurements. BMD was lower at the lumbar spine and all
sites in the hip in patients with VF than in control subjects (p<0.001). Potential underlying causes of secondary osteoporosis were found in 41% of men with VF, compared with 9% of control
subjects (OR 7.1; 95% CI 3.1–16.4). Oral corticosteroid and anticonvulsant treatment were both associated with a significantly
increased risk of VF (OR 6.1; 95% CI 1.3–28.4). Although hypogonadism was not associated with an increased risk of fracture,
the level of sex hormone binding globulin was higher (p<0.001) and the free androgen index lower (p<0.001) in men with VF than control subjects. Other factors associated with a significantly increased risk of VF were family
history of bone disease (OR 6.1; 95% CI 1.3–28.4), current smoking (OR 2.8; 95% CI 1.2–6.7) and alcohol consumption of more
than 250 g/week (OR 3.8; 95% CI 1.7–8.7). Men with VF were more likely to complain of back pain (p<0.001) and greater loss of height (p<0.001) than control subjects, and had poorer (p<0.001) scores for the energy, pain, emotion, sleep and physical mobility domains of the Nottingham Health Profile. We conclude
that symptomatic VF in men are associated with reduced BMD, underlying causes of secondary osteoporosis such as corticosteroid
and anticonvulsant treatment, family history of bone disease, current smoking and high alcohol consumption, and that they
impair the perceived health of the individual.
Received: 23 February 1998 / Accepted: 13 May 1998 相似文献
8.
S. M. F. Pluijm M. G. Dik C. Jonker D. J. H. Deeg D. J. H. Deeg G. J. van Kamp P. Lips P. Lips 《Osteoporosis international》2002,13(9):701-709
The aim of this study was to examine whether the presence of apolipoprotein E ε4 (ApoE ε4) is associated with a lower bone
mineral density (BMD), lower quantitative ultrasound (QUS) measurements, higher bone turnover and fracture risk, and whether
these relations are modified by gender and age. A total of 1406 elderly men and women (≥65 years) of the Longitudinal Aging
Study Amsterdam (LASA) participated in this study. In all participants, QUS measurements were assessed, as well as serum osteocalcin
(OC) and urine deoxypyridinolin (DPD/Cr urine). Follow-up of fractures was done each three months. In a subsample (n = 604), total body bone mineral content (BMC) and BMD of the hip and lumbar spine were measured. In addition, prevalent vertebral
deformities were identified on radiographs. In women, the presence of ApoE ε4 was associated with significantly lower femoral
neck BMD (g/cm2; mean ± SEM; ε4+, 0.64 ± 0.01 vs. ε4−, 0.67 ± 0.01; p= 0.04), lower trochanter BMD (g/cm2; mean ± SEM; ε4+, 0.58 ± 0.01 vs. ε4–, 0.61 ± 0.01; p= 0.01) and lower total body BMC (g; mean ± SEM; ε4+, 1787 ± 40.0 vs. ε4–, 1863 ± 23.8; p= 0.04). Women with ApoE ε4 also had a higher risk of severe vertebral deformities (OR=2.78; 95%CI: 1.21–6.34). In men, the
associations between ApoE status and both hip BMD and QUS depended on age. Only among the younger men (65–69 years) was the
presence of ApoE ε4 associated with lower BMD values. Bone markers and fractures were not associated with ApoE ε4 in either
women, or men. In conclusion, this large community-based study confirms the importance of ApoE ε4 as a possible genetic risk
factor related to BMD and vertebral deformities and demonstrates that its effect is gender related, and depends on age in
men only.
Received: 6 July 2001 / Accepted: 2 April 2002 相似文献
9.
Bone Mineral Density and Vertebral Fractures in Men 总被引:1,自引:0,他引:1
E. Legrand D. Chappard C. Pascaretti M. Duquenne C. Rondeau Y. Simon V. Rohmer M.-F. Basle M. Audran 《Osteoporosis international》1999,10(4):265-270
In women, many studies indicate that the risk of vertebral fragility fractures increases as bone mineral density (BMD) declines.
In contrast, few studies are available for BMD and vertebral fractures in men. It is uncertain that the strength of the relationship
between BMD and fractures is similar in magnitude in middle-aged men and in postmenopausal women. In the present study, 200
men (mean age 54.7 years) with lumbar osteopenia (T-score <−1.5) were recruited to examine the relationships between spine BMD and hip BMD and the associations of BMD with vertebral
fractures. Lumbar BMD was assessed from L2 to L4, in the anteroposterior view, using dual-energy X-ray densitometry. At the
upper left femur, hip BMD was measured at five regions of interest: femoral neck, trochanter, intertrochanter, Ward’s triangle
and total hip. Spinal radiographs were analyzed independently by two trained investigators and vertebral fracture was defined
as a reduction of at least 20% in the anterior, middle or posterior vertebral height. Spinal radiographs evidenced at least
one vertebral crush fracture in 119 patients (59.5%). The results of logistic regression showed that age, femoral and spine
BMDs were significant predictors of the presence of a vertebral fracture. Odds ratios for a decrease of 1 standard deviation
ranged from 1.8 (1.3–2.8) for spine BMD to 2.3 (1.5–3.6) for total hip BMD. For multiple fractures odds ratios ranged from
1.7 (1.1–2.5) for spine BMD to 2.6 (1.7–4.3) for total hip BMD. In all models, odds ratios were higher for hip BMD than for
spine BMD, particularly in younger men, under 50 years. A T-score <−2.5 in the femur (total femoral site) was associated with a 2.7-fold increase in the risk of vertebral fracture while
a T-score <−2.5 in the spine was associated with only a 2-fold increase in risk. This study confirms the strong association of
age and BMD with vertebral fractures in middle-aged men, shows that the femoral area is the best site of BMD measurement and
suggests that a low femoral BMD could be considered as an index of severity in young men with lumbar osteopenia.
Received: 27 October 1998 / Accepted: 22 February 1999 相似文献
10.
Osteoporotic vertebral deformities may be detected by morphometric radiography (MR) using spinal radiographs, and by morphometric
X-ray absorptiometry (MXA) using dual-energy X-ray absorptiometry. Reference values for MR may not be appropriate for MXA,
and reference values may be affected by gender and age. The aims of this study were to (1) compare mean deformity of vertebral
height ratios for MR and MXA in men, (2) compare mean deformity for MXA in men and women, (3) compare mean wedge angle measured
by MXA in men and women and (4) assess the effect of aging on MXA values in men. We studied a general practitioner sample
of 115 men aged 22–81 years (mean 53 years) and 124 women aged 55–89 years (mean 68 years). Subjects had MXA of T4 to L4 using
the Hologic QDR 4500A. Women and men over age 50 years had radiographs of the thoraco-lumbar spine. Scans and radiographs
were marked in the same way by one operator and vertebral height ratios and mean deformity were calculated for MR and MXA.
The mean wedge angle, θ, was calculated for MXA in all subjects. Mean wedge and biconcavity deformity and standard deviation
(SD) in men were greater for MXA than for MR. The mean wedge and biconcavity deformity measured by MXA tended to be greater
for men than for women. Vertebral deformity in men increased with age, and was associated with degenerative change seen on
spinal radiographs. The mean wedge angle was greater for men than for women, and it increased with age in men. We conclude
that sex- and age-specific reference ranges should be established separately for MXA.
Received: 14 September 1998 / Accepted: 28 January 1999 相似文献
11.
12.
A. N. A. Tosteson S. E. Gabriel M. R. Grove M. M. Moncur T. S. Kneeland L. J. Melton III 《Osteoporosis international》2001,12(12):1042-1049
The objective of the study was to estimate the impact of hip and vertebral fractures on quality of life in postmenopausal
women using a preference-based health measure that is appropriate for economic evaluations and to investigate correlates of
health outcome. Interviews to assess health-related quality of life, which also documented other health conditions and characteristics,
were undertaken in women age 50 years and older without osteoporotic fractures compared with women with hip and/or vertebral
fracture(s). Health status was characterized by self-reported physical limitations and the mental and physical component summary
scores of the SF-36. Quality-adjusted life years (QALYs), which reflect each individual’s assessment of her overall health
utility, were estimated with time tradeoff values. Regression methods were used to examine QALY correlates (e.g. time since
fracture) for each fracture group and to estimate differences in QALYs between fracture and non-fracture subjects after accounting
for other patient characteristics. Among 382 women ages 50–96 years, fracture subjects were significantly older, less likely
to use hormone replacement therapy and more likely to report physical limitations than non-fracture subjects. On the QALY
scale, where 1 represents perfect health and 0 represents death, mean QALY values were 0.82 (95% CI: 0.76, 0.87) among 114
women with one or more vertebral fractures and 0.63 (95% CI: 0.52, 0.74) among 67 with hip fracture compared with 0.91 (95%
CI: 0.88, 0.94) among 201 women without fracture. No significant correlates of QALYs were identified among women with vertebral
fracture alone. Among hip fracture subjects, time since hip fracture and presence of a vertebral fracture were significant
correlates of QALYs. In multiple regression analyses, estimated QALY differences (fracture minus non-fracture subjects) ranged
from –0.05 to –0.55 and were equivalent to losses of 20–58 days, 23–65 days and 115–202 days per year for vertebral fracture
(p= 0.001), hip fracture (p= 0.009) and hip plus vertebral fracture (p<0.001) subjects, respectively, depending on age. Thus to adequately assess the cost-effectiveness of osteoporosis treatment,
the negative impact of vertebral fractures on QALYs, even among women who have survived a hip fracture, must be considered.
Received: 2 February 2001 / Accepted: 23 July 2001 相似文献
13.
P. Lips C. Cooper D. Agnusdei F. Caulin P. Egger O. Johnell J. A. Kanis S. Kellingray A. Leplege U. A. Liberman E. McCloskey H. Minne J. Reeve J.-Y. Reginster M. Scholz C. Todd M. C. de Vernejoul I. Wiklund 《Osteoporosis international》1999,10(2):150-160
Vertebral fractures may be minor or lead to pain, decreased physical function, immobility, social isolation and depression,
which together contribute to quality of life. A Working Party of the European Foundation for Osteoporosis has developed a
specfic questionnaire for patients with vertebral fractures. This questionnaire, QUALEFFO, includes questions in the domains
pain, physical function, social function, general health perception and mental function. QUALEFFO was validated in a multicenter
study in seven countries. The study was done in 159 patients aged 55–80 years with clinical osteoporosis, i.e., back pain
and other complaints with at least one vertebral fracture and lumbar bone mineral density T-score <−1. Patients with a recent vertebral fracture were excluded because of unstable disease. Controls were age- and sex-matched,
and did not have chronic back pain or vertebral fractures. Subjects with conditions exerting a major influence on quality
of life were excluded. The QUALEFFO was administered twice within 4 weeks and compared with a generic questionnaire, the Short
Form 36 of the Medical Outcomes Study (SF-36). Standard spinal radiographs were made for assessment of vertebral height. Seven
questions were removed from the analysis because of low response rate, linguistic ambiguities or redundancy. The 41 remaining
questions were analyzed for repeatability, internal consistency and the capacity to discriminate between patients with vertebral
fractures and controls. Comparison with the SF-36 was performed within similar domains by conditional logistic regression
and by receiver operating characteristic (ROC) curves. The repeatability of QUALEFFO was good (kappa statistics 0.54–0.90)
and 26 of 41 questions had a kappa score ≥0.70. The internal consistency of the five domains was adequate, with Crohnbach
α around 0.80. All except five questions discriminated significantly between patients and controls. The median scores of QUALEFFO
were significantly higher in patients with vertebral fractures than in controls in all five domain (p<0.001), which is consistent with decreased quality of life in patients with osteoporosis. Spinal radiographs were assessed
using the McCloskey–Kanis algorithm. According to this, 124 patients (78%) had vertebral fractures of ≥3 SD severity, in contrast
with 7 controls (4%). Significant correlations existed between scores of similar domains of QUALEFFO and the SF-36, especially
for pain, physical function and mental function. All five domains within each questionnaire discriminated significantly between
fracture cases and controls. The odds ratios for pain and social function were greater for QUALEFFO, while general health
perception was more discriminating using the SF-36. The ROC curve analysis of QUALEFFO indicated that all five domains were
significantly predictive of vertebral fractures. When comparing similar domains of the two questionnaires, QUALEFFO domains
demonstrated significantly better performance for pain, physical function and social function. The QUALEFFO total score and
SF-36 physical composite score showed similar performance. In conclusion, QUALEFFO is repeatable, coherent and discriminates
well between patients with vertebral fractures and control subjects. The results of this study confirm the decreased quality
of life in patients with vertebral fractures.
Received: 4 August 1998 / Accepted: 28 December 1998 相似文献
14.
Vertebral Fractures Predict Subsequent Fractures 总被引:18,自引:5,他引:13
L. J. Melton III E. J. Atkinson C. Cooper W. M. O’Fallon B. L. Riggs 《Osteoporosis international》1999,10(3):214-221
This population-based study documents an increase in most types of fractures following the occurrence of a clinically recognized
vertebral fracture among 820 Rochester, Minnesota, residents. During 4349 person-years of follow-up, 896 new fractures were
observed. Relative to incidence rates in the community, there was a 2.8-fold increase in the risk of any fracture, which was
greater in men (standardized incidence ratio (SIR), 4.2; 95% CI, 3.2–5.3) than women (SIR, 2.7; 95% CI, 2.4–3.0). The estimated
cumulative incidence of any fracture after 10 years was 70%. The greatest increase in risk was for subsequent fractures of
the axial skeleton, in particular a 12.6-fold increase (95% CI, 11–14) in additional vertebral fractures. There was a lesser
increase in most limb fractures, including a 2.3-fold increase (95% CI, 1.8–2.9) in hip fractures and a 1.6-fold increase
(95% CI, 1.01–2.4) in distal forearm fractures. There was a slightly greater association with distal forearm fractures among
those whose first vertebral fracture occurred before age 70 years but a similar relationship with hip fractures, including
cervical and intertrochanteric hip fractures separately, regardless of age at the initial vertebral fracture. There was also
an equivalent increase in subsequent fracture risk whether the initial vertebral fracture was attributed to severe or moderate
trauma. These data show that vertebral fractures represent an important risk factor for fractures in general, not just those
of the spine and hip.
Received: 2 September 1998 / Accepted: 9 February 1999 相似文献
15.
The Effects of Lifestyle, Dietary Dairy Intake and Diabetes on Bone Density and Vertebral Deformity Prevalence: The EVOS Study 总被引:9,自引:0,他引:9
M. Lunt P. Masaryk C. Scheidt-Nave J. Nijs G. Poor H. Pols J. A. Falch G. Hammermeister D. M. Reid L. Benevolenskaya K. Weber J. Cannata T. W. O”Neill D. Felsenberg A. J. Silman J. Reeve 《Osteoporosis international》2001,12(8):688-698
The risk of low and moderate energy fracture is related to bone mineral density (BMD). Yet it is uncertain whether the epidemiologic
determinants of fracture risk are the same as for low bone density. The European Vertebral Osteoporosis Study was a population-based
prevalence study of vertebral deformity in 36 age-stratified population samples aged 50–80 years. In nearly 4000 subjects
(13 centers), BMD measurements were also made at the spine, femoral neck and femoral trochanter. To investigate whether effects
of reported physical activity on spine deformity risk were mediated through BMD, we modeled these and other risk factor data
with BMD as the dependent variate after adjusting for age, center, sex and body mass index (BMI). The significant determinants
of vertebral deformity risk were also entered into logistic models of deformity risk that included BMD measurements as covariates.
Both current and lifetime physical activity were positively associated with BMD. This effect was stronger with hip BMD than
with spine BMD. Lifetime smoking exposure was associated with reduced BMD. Type 2 diabetes mellitus was associated with increased
BMD. Weak positive associations were found between consumption of dairy products and BMD at the three measured sites and these
were strengthened by an interaction with measures of physical activity in men. Physical activity in women had the largest
beneficial effect in lean women and in women exposed to hormone replacement therapy. When fracture risk was modeled with BMD
as a covariate, the lifestyle and dietary determinants became less strongly related to vertebral deformity risk, suggesting
that BMD may have acted as an intermediary variable. However, heavy physical activity in men still increased spine deformity
risk after adjusting for BMD. It is concluded that physical activity in both genders and milk consumption in young women might
protect against vertebral deformities in later life through their effects on bone density. The adverse effect of smoking on
BMD was confirmed. Heavy physical activity in men might increase spine deformity risk even when BMD is normal.
Received: 29 June 2000 / Accepted: 5 January 2001 相似文献
16.
D. J. Cook G. H. Guyatt J. D. Adachi R. S. Epstein E. F. Juniper P. A. Austin J. Clifton C. J. Rosen C. R. Kessenich J. L. Stock J. Overdorf P. D. Miller A. L. Erickson M. R. McCLung B. L. McClung L. E. Griffith D. J. Cook G. Ioannidis 《Osteoporosis international》1999,10(3):207-213
The objective of the study was to evaluate a shortened osteoporosis quality of life questionnaire (OQLQ) in osteoporotic
women with back pain due to vertebral fractures. From the longer 30-item OQLQ (four to nine items per domain) we created the
mini-OQLQ by choosing the two items with the highest impact in each of five domains (symptoms, physical function, activities
of daily living, emotional function, leisure). We administered the OQLQ, the Sickness Impact Profile, the SF-36 and the Brief
Pain Index to patients at baseline, after 2 weeks and after 6 months. The intraclass correlations between baseline and the
2-week follow-up for the five mini-OQLQ domains ranged from 0.72 to 0.86. Cross-sectional correlations between the domains
of the mini-OQLQ and other health instruments were moderate to large (0.35–0.80) and greater than predicted. The mini-OQLQ
items showed moderate to large correlations with items omitted from the shortened questionnaire (0.44–0.88). Correlations
between the OQLQ domains and the other three instruments were greater than those of the mini-OQLQ, and partial correlations
between OQLQ items omitted from the mini-OQLQ and the other three instruments after considering mini-OQLQ items were substantial
(0.19–0.71) and statistically significant. Sample sizes of less than 200 per group should be required to detect minimally
important differences in parallel-group clinical trials. Longitudinal correlations between the mini-OQLQ and the other measures
were often significant but generally lower than predicted (0.10–0.49). The partial correlations revealed that the omitted
items explained a significant portion of the longitudinal variance in each domain. We conclude that in a selected group of
patients with back pain caused by vertebral fractures, the mini-OQLQ demonstrated good discriminative and adequate evaluative
properties. The mini-questionnaire should be useful in clinical settings.
Received: 14 September 1998 / Accepted: 8 February 1999 相似文献
17.
Visual Assessment of Vertebral Deformity by X-ray Absorptiometry: A Highly Predictive Method to Exclude Vertebral Deformity 总被引:6,自引:6,他引:0
J. A. Rea J. Li G. M. Blake P. Steiger H. K. Genant I. Fogelman 《Osteoporosis international》2000,11(8):660-668
The accurate identification of prevalent vertebral fractures is important in both the clinical and research setting as they
are associated with increased risk of further fracture and irreversible clinical consequences. This study reports a direct
comparison of prevalent vertebral deformity identification using X-ray absorptiometry (XA) scans, acquired on a dual-energy
X-ray absorptiometry (DXA) machine, and conventional radiographs in a diverse group of 161 postmenopausal women, ranging from
healthy subjects with normal bone mineral density (BMD) to osteoporotic subjects with multiple vertebral deformities. Deformities
were identified by a trained operator by visual assessment of the XA scans (VXA) and semiquantitatively by an experienced
radiologist on the conventional radiographs (XSQ). Subjects were recruited prospectively and were triaged according to their
VXA results into normal, equivocal and definite deformity groups. VXA and XSQ demonstrated good agreement (96.3%, κ= 0.79)
in classifying vertebrae as normal or deformed in the 1978 of 2093 vertebrae deemed analyzable on both the XA scans and conventional
radiographs. VXA showed good sensitivity (91.9%) in the identification of moderate/severe XSQ deformities and an excellent
negative predictive value (98.0%) was produced when VXA was used to distinguish subjects without vertebral deformities from
those with possible or definite deformities on a per subject basis. The majority of disagreement between the two methods resulted
from different classification of mild wedge and endplate deformities and the poor visualization of upper thoracic vertebrae
on the XA scans. Agreement improved, particularly on a per subject basis, when analysis was restricted to the vertebral levels
from L4 to T7. Visual triage of XA scans by a trained operator would seem to be swift, convenient and cost-effective method,
with excellent negative predictive value, to distinguish subjects with very low risk of vertebral deformities from those with
possible deformities. These ‘normal’ subjects can then be excluded prior to performing conventional radiographs and further
time-consuming and costly methods of vertebral deformity assessment such as XSQ by an experienced radiologist and/or quantitative
morphometry. VXA may prove useful in the clinical evaluation of patients at risk of osteoporosis as an adjunct to BMD scans
or in the selection of subjects for osteoporosis-related clinical trials.
Received: 27 July 1999 / Accepted: 4 February 2000 相似文献
18.
Morphometric X-ray absorptiometry (MXA) has not been evaluated for the identification of incident vertebral deformities.
The reliability of longitudinal measurements in quantitative vertebral morphometry is influenced by the precision of the technique.
Long-term precision in vitro (weekly MXA phantom scans) assessed by retrospective cumulative sum (Cusum) analysis, detected
one event during a 6-month period when the measurement process was “out of control”. Inspection of service records revealed
that repair work was performed around this timepoint. The coefficient of variation (CV) for long-term precision (vertebral
heights) in a population-based sample of postmenopausal women ages 56 to 83, mean 65 ± 6 years (n= 48), was 4.0% for morphometric radiography (MRX), 2.9% for MXA using the compare facility for analysis of serial scans,
and 3.2% when “compare” was not used. In women with osteoporosis ages 49 to 87, mean 67 ± 9 years (n= 50), the CV was 5.0% for MRX, 4.1% for MXA using “compare” and 8.5% without “compare”. Precision errors for height ratios
(MRX and MXA) were greater than for vertebral heights. Incident deformities were identified by MRX and MXA in the women with
osteoporosis, using point prevalence, 20% minimum reduction in vertebral height, and percent least significant change (LSC)
in vertebral heights and height ratios. Semiquantitative analysis of radiographs by a radiologist (Genant method) was used
as the gold standard. The results were similar for MRX and MXA, and all morphometric criteria identified a similar proportion
of true incident deformities, although the false positive rate was generally greater for the height ratio approaches. MXA
has good long-term precision and is comparable to MRX for the identification of incident deformities when scans are analyzed
with the compare facility.
Received: 31 July 2000 / Accepted: 6 February 2001 相似文献
19.
Performance of COLIA1 Polymorphism and Bone Turnover Markers to Identify Postmenopausal Women with Prevalent Vertebral Fractures 总被引:3,自引:0,他引:3
P. Mezquita-Raya M. Muñoz-Torres J. de Dios Luna F. Lopez-Rodriguez J. M. Quesada F. Luque-Recio F. Escobar-Jiménez 《Osteoporosis international》2002,13(6):506-512
Some studies have suggested that bone turnover markers (BTM) and collagen type I alpha 1 gene (COLIA1) may be useful in the
prediction of rates of future bone loss, and may therefore provide information about fracture risk. Our study aimed to examine
the association of the COLIA1 genotype with the risk of vertebral fracture and to investigate the predictive value of this
genetic factor in comparison with bone mineral density (BMD) and BTM, in ambulatory postmenopausal Spanish women. We determined
the COLIA1 polymorphism by polymerase chain reaction, BMD by dual-energy X-ray absorptiometry and BTM in 43 postmenopausal
women with prevalent vertebral fracture and a control group of 101 postmenopausal women without fracture. There was a significant
overrepresentation of the ‘T’ allele in fractured women (p= 0.029). BTM exhibited no differences between women with or without fractures or COLIA1 genotype groups. After adjusting
for all other variables, the osteoporosis densitometric criteria variable was the most strongly associated with fracture (OR
= 5 [1.8–13.3]) followed by COLIA1 (OR = 2.1 [1–4.3] per copy of the ‘T’ allele). Our study shows that COLIA1 is associated
with prevalent vertebral fracture independently of bone mass, and the performance of this genetic factor to assess prevalent
vertebral fracture is better than bone turnover markers.
Received: 29 June 2001 / Accepted: 11 December 2001 相似文献
20.
Vertebral Fracture Definition from Population-Based Data: Preliminary Results from the Canadian Multicenter Osteoporosis Study (CaMos) 总被引:9,自引:9,他引:0
The Canadian Multicenter Osteoporosis Study is a large population-based prospective study of osteoporosis in the Canadian
population. The study involves 9424 subjects, both male and female, from nine centers and seven regions of Canada. Each subject
completed an extensive interview to obtain medical, demographic and lifestyle information, and was examined by dual-energy
X-ray absorptiometry of the spine and hip, ultrasound of the heel and, for subjects over 50 years of age, lateral spine radiographs.
Spinal morphometry of the initial radiographs was performed to determine the prevalence of vertebral deformity. A method is
utilized to extract reference norms for vertebral shape from a subset of the population data, which is then used to categorize
any deformity within the whole data set. Using 3 standard deviations (SD) as a limit of normality, the male prevalence of
21.5% was similar to the female prevalence of 23.5%. Using 4 SD this reduced to 7.3% and 9.3% respectively. The younger men
(50–59 years) showed a higher prevalence of deformity than the women and a lower increase of prevalence with age. In the older
age group (over 80 years) the female prevalence of 45% compared with 36% for the men using 3 SD (grade 1) to define the limit
of normality. The female group presented with more severe deformities on average than the male group. This continuing study
will provide longitudinal information regarding the development of osteoporosis and associated risk factors which will eventually
be of use to develop public health policies.
Received: 27 September 1999 / Accepted: 4 February 2000 相似文献