Association of lumbar disc degeneration with osteoporotic fractures; the Rotterdam study and meta-analysis from systematic review

被引:34
作者
Castano-Betancourt, M. C. [1 ,2 ,3 ]
Oei, L. [1 ,2 ,3 ]
Rivadeneira, F. [1 ,2 ,3 ]
de Schepper, E. I. T. [4 ]
Hofman, A. [3 ]
Bierma-Zeinstra, S. [4 ]
Pols, H. A. P. [1 ]
Uitterlinden, A. G. [1 ,2 ,3 ]
Van Meurs, J. B. J. [1 ,2 ]
机构
[1] Erasmus MC, Dept Internal Med, NL-3000 DR Rotterdam, Netherlands
[2] Netherlands Genom Initiat Sponsored Netherlands C, NL-2300 RC Leiden, Netherlands
[3] Erasmus MC, Dept Epidemiol, NL-3000 DR Rotterdam, Netherlands
[4] Erasmus MC, Dept Gen Practice, NL-1136 GK Rotterdam, Netherlands
关键词
Lumbar disc degeneration; Osteoporotic fractures; Bone Mineral Density; Disc space narrowing; Vertebral fractures; BONE-MINERAL DENSITY; QUALITY-OF-LIFE; POSTMENOPAUSAL WOMEN; VERTEBRAL FRACTURES; RISK-FACTORS; BACK-PAIN; INCIDENT; OSTEOARTHRITIS; SPINE; MEN;
D O I
10.1016/j.bone.2013.08.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To investigate the relation between lumbar disc degeneration (LDD) and all type of osteoporotic (OP) fractures including vertebral. Methods: This study is part of the Rotterdam study, a large prospective population-based cohort study among men and women aged 55 years and over. In 2819 participants spine radiographs were scored for LDD (osteophytes and disc space narrowing (DSN)) from L1 till Si, using the Lane atlas. Osteoporotic (OP) fracture data were collected and verified by specialists during 12.8 years. We considered two types of vertebral fractures (VFx): Clinical VFx (symptomatic fractures recorded by medical practitioners) and Radiographic VFx (using the McCloskey-Kanis method). Meta-analysis of published studies reporting an association of LDD features and VFx was performed. Differences in Bone Mineral Density (BMD) between participants with and without LDD features were analyzed using ANOVA. Risk of OP-fractures was analyzed using Cox regression. Results: In a total of 2385 participants, during 12.8 years follow-up, 558 suffered an OP-fracture. Subjects with LDD had an increased OP fracture risk compared to subjects without LDD (HR: 129, CI: 1.04-1.60). LDD-cases have between 03 and 0.72 standard deviations more BMD than non-cases in all analyzed regions including total body BMD and skull BMD (P < 0.001). Only males with LDD had increased risk for OP-fractures compared to males without LDD (adjusted-HR: 1.80, 95%CI 1.20-2.70, P = 0.005). The risk was also higher for VFx in males (HR: 1.64, CI: 1.03-2.60, P: 0.04). The association LDD-OP-fractures in females was lower and not significant (adjusted-HR: 1.08, 95%CI: 0.82-1.41). Meta-analyses showed that the risk of VFx in subjects with LDD has been studied only in women and there is not enough evidence to confidently analyze the relationship between LDD-features (DSN or/and OPH) and VFx due to low power and heterogeneity in phenotype definition in the collected studies. Conclusions: Male subjects with LDD have a higher osteoporotic fracture risk, in spite of systemically higher BMD. (C) 2013 Elsevier Inc. All rights reserved.
引用
收藏
页码:284 / 289
页数:6
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