Lumbar disc degeneration in osteoporotic men: prevalence and assessment of the relation with presence of vertebral fracture.
TL;DR: In osteoporotic men, the prevalence of lumbar spine degeneration is high and no relationship was found between the presence and/or the severity of osteophytes and disc narrowings and the presence of prevalent vertebral radiographic fractures.
Abstract: Objective. The relationship between osteoarthritis (OA) and osteoporosis (OP) remains controversial. An inverse relationship between spine OA and the presence of prevalent vertebral fractures has been shown in osteoporotic women. Our objective was to assess this relationship in osteoporotic men. Methods. All the patients had OP based on densitometric data and were aged ≥ 65 years. Spine radiographs were performed according to a standardized procedure. Vertebral fractures were assessed from T4 to L4 by a semiquantitative method. Disc degenerative changes were assessed by the presence and severity of osteophytes and disc narrowing at levels T12–L1 to L5–S1. Logistic regression was used to study the relationship between the presence of vertebral fracture and lumbar disc degeneration. Results. The study included 261 osteoporotic men. The prevalence of vertebral fractures was 26.4% (69/261). At least 1 osteophyte was found in 91.6% (239/261) of patients, and at least 1 disc space narrowing in 63.5% (165/260). The prevalence of at least 1 osteophyte and/or at least 1 disc space narrowing was similar in patients with and those without vertebral fracture. No relationship was found between the presence and/or the severity of osteophytes and disc narrowings and the presence of prevalent vertebral radiographic fractures. Conclusion. In osteoporotic men, the prevalence of lumbar spine degeneration is high. There is no relationship between lumbar disc degeneration and the presence of vertebral fracture in osteoporotic men.
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TL;DR: Recent evidence suggests that morphometric (quantitative) criteria are inferior to morphologic (qualitative; ie, based on structural integrity) vertebral damage assessment in identifying people with low bone density and at an increased risk of future fracture, so there is now an evidentiary basis for suggesting that morphological assessment is the preferred strategy for use in diagnosing OVF from radiographs.
Abstract: Until recently there has been little evidence available to validate any method by which to make an accurate diagnosis of an osteoporotic vertebral fractures (OVFs) from plain radiographs. In part this reflects a lack of a completely satisfactory "gold standard," but primarily it relates to the absence of well-designed prospective studies in this context. Historically, OVFs were recognized by evidence of macroscopic structural failure in vertebrae using the criteria applied elsewhere in the skeleton. This comprised altered alignment, fragmentation, cortical disruptions, and breaks, among other changes. However, these morphological criteria were replaced by vertebral morphometry, referring to the use of quantitative or quasi-quantitative measurement tools for fracture diagnosis. Vertebral morphometry emerged as an understanding of and treatment for osteoporosis evolved, mainly in response to the need for expeditious assessments of large numbers of spine images for epidemiological and pharmaceutical purposes. Although most of the descriptions of such morphometric tools have stressed that they were not to be applied to clinical diagnosis with respect to individual patients, this constraint has been widely disregarded. Here we review the major attempts to develop a diagnostic strategy for OVF and describe their characteristics in adults and children. Recent evidence suggests that morphometric (quantitative; ie, based on measurement of dimensions and shape description) criteria are inferior to morphologic (qualitative; ie, based on structural integrity) vertebral damage assessment in identifying people with low bone density and at an increased risk of future fracture. Thus there is now an evidentiary basis for suggesting that morphological assessment is the preferred strategy for use in diagnosing OVF from radiographs. © 2019 American Society for Bone and Mineral Research.
56 citations
Cites background or methods from "Lumbar disc degeneration in osteopo..."
...Later, Fabrequet and colleagues,((38)) in a study of degenerative disease in men in France, used the GSQ tool but only accepted that a vertebra was fractured if it also betrayed evidence of structural damage; ie, qualitative evidence of fracturing....
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...The methods used by these investigators suggest the need for pedagogical programs to support scientific evidence related to vertebral fracture diagnosis.((38)) During extensive revision of incident vertebral fractures from radiographs of clinical trials at Sheffield University, Jiang and colleagues((39)) noted that all such fractures involved endplate deformity and in 2004, proposed the use of a structured version of the morphologic (qualitative) approach to fracture diagnosis: the ABQ tool....
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TL;DR: The potential of endogenous repair in the IVD, the recent findings on endogenous IVD progenitor cells, and stem cell niches involved in IVD endogenous repair are discussed, and the factors which may restrict IVD self-healing are highlighted.
Abstract: Intervertebral disc (IVD) disorders, especially degenerative disc disease, reduce the quality of life, and are short of effective therapy. A new direction for treatment of chronic tissue and organ diseases is to promote regeneration by harnessing endogenous repair mechanisms. In this review, we discuss the potential of endogenous repair in the IVD, the recent findings on endogenous IVD progenitor cells, and stem cell niches involved in IVD endogenous repair. We also highlight the factors which may restrict IVD self-healing. Ultimately, advanced therapeutic attempts to boost endogenous repair in the IVD are discussed, including bioactive factor delivery, gene therapy, activation of endogenous IVD progenitor cells and chemokine mediated stem cell homing.
33 citations
Cites background from "Lumbar disc degeneration in osteopo..."
...In addition, osteoporosis was also found to be associated with high prevalence of lumbar disc degeneration [104]....
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TL;DR: The purpose of this review was to examine the diagnostic radiological strategies available and suggest a coherent approach to diagnosis, and to suggest relative reductions in vertebral height may not be a necessary nor sufficient criterion by which to diagnose a fracture.
32 citations
Additional excerpts
...Notably, recent research reports involving the analysis of vertebral fractures has only recognized fractures, as graded by the Genant method, if there is also evidence of end-plate or cortical damage (33,34)....
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TL;DR: Although BPAQ-derived estimates of physical activity are related to bone status in healthy middle-aged and older men, the adverse effect of AST on bone appears to obscure this relationship in men with prostate cancer.
Abstract: The bone-specific physical activity questionnaire (BPAQ) accounts for activities that affect bone but has not been used in studies with older adults. Relationships exist between the BPAQ-derived physical activity and bone density in healthy middle-aged and older men but not men with prostate cancer. Disease-related treatments detrimental to bone should be considered when administering the BPAQ.
19 citations
Cites background from "Lumbar disc degeneration in osteopo..."
...A likely explanation for the lack of BPAQ relationship and the discrepancy between spine and hip BMD is the presence of osteoarthritic degeneration, specifically osteophytes, which are highly prevalent in the spines of older men [18]....
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TL;DR: There has been limited evidences to validate published criterium by which to make an accurate diagnosis of an oVF based on radiographs, and the semi-quantitative (SQ) grading scheme to evaluate osteoporotic vertebral deformity (oVD) was proposed.
Abstract: While osteoporotic vertebral fracture (oVF) is very common and has important clinical relevance, until recently there has been limited evidences to validate published criterium by which to make an accurate diagnosis of an oVF based on radiographs (1). Purely morphometric approach without qualitative, i.e., radiological, assessment of vertebral morphology can lead to both ‘over-call’ and ‘under-call’ of oVFs (1). In the early 90’s, Genant and colleagues at University of California at San Francisco (UCSF) proposed the semi-quantitative (SQ) grading scheme to evaluate osteoporotic vertebral deformity (oVD) (2).
17 citations
References
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TL;DR: The semiquantitative approach can be applied reliably in vertebral fracture assessment when performed using well‐defined criteria, and this approach was compared with a quantitative morpho‐metric approach.
Abstract: The assessment of vertebral fracture by conventional radiography has been refined and improved using either semiquantitative or quantitative criteria. The inter- and intraobserver variability was determined for a semiquantitative visual approach that we routinely use in clinical studies for assessing prevalent and incident vertebral fractures. In addition, the semiquantitative approach was compared with a quantitative morphometric approach. The incidence and prevalence of vertebral fractures were determined in 57 postmenopausal women (age 65-75 years) by three independent observers. The radiographic basis for fracture definitions and the source of interobserver agreement for the semiquantitative technique. We conclude that the semiquantitative approach can be applied reliably in vertebral fracture assessment when performed using well-defined criteria.
3,019 citations
TL;DR: The purpose of this review is to illustrate how each of these factors interact together to instigate incident OA as well as to outline the need for ongoing epidemiologic studies for the future prevention of both incident and progressive OA.
Abstract: Osteoarthritis (OA) is a leading cause of disability and its incidence is rising due to increasing obesity and an ageing population. Risk factors can be divided into person-level factors, such as age, sex, obesity, genetics, race/ethnicity and diet, and joint-level factors including injury, malalignment and abnormal loading of the joints. The interaction of these risk factors is complex and provides a challenge to the managing physician. The purpose of this review is to illustrate how each of these factors interact together to instigate incident OA as well as to outline the need for ongoing epidemiologic studies for the future prevention of both incident and progressive OA. It is only by understanding the impact of this disease and the modifiable risk factors that we will be able to truly target public health prevention interventions appropriately.
1,504 citations
TL;DR: By inhibiting Dickkopf-1 (DKK-1), a regulatory molecule of the Wnt pathway, this work was able to reverse theBone-destructive pattern of a mouse model of rheumatoid arthritis to the bone-forming pattern of osteoarthritis, suggesting that the WNT pathway is a key regulator of joint remodeling.
Abstract: Degenerative and inflammatory joint diseases lead to a destruction of the joint architecture. Whereas degenerative osteoarthritis results in the formation of new bone, rheumatoid arthritis leads to bone resorption. The molecular basis of these different patterns of joint disease is unknown. By inhibiting Dickkopf-1 (DKK-1), a regulatory molecule of the Wnt pathway, we were able to reverse the bone-destructive pattern of a mouse model of rheumatoid arthritis to the bone-forming pattern of osteoarthritis. In this way, no overall bone erosion resulted, although bony nodules, so-called osteophytes, did form. We identified tumor necrosis factor-a (TNF) as a key inducer of DKK-1 in the mouse inflammatory arthritis model and in human rheumatoid arthritis. These results suggest that the Wnt pathway is a key regulator of joint remodeling. Affliction of joints is the hallmark of rheumatic disease. In addition to pain, both degenerative and inflammatory rheumatic diseases lead to a profound remodeling of the joint architecture, which causes functional disability and progressive crippling. This structural damage is largely responsible for the high socioeconomic burden of rheumatic disease, and definition of its molecular mechanism is therefore of key interest 1 .
1,225 citations
TL;DR: Differences between men and women were small except for hips and knees; however, severe radiological osteoarthritis was found in a higher proportion in most of the joints in women, and differences between populations were mainly differences in level.
Abstract: The prevalence of mild and severe radiological osteoarthritis was investigated in a random sample of 6585 inhabitants of a Dutch village. Radiographs were graded 0-4 according to the criteria described by Kellgren and Lawrence. The prevalence of radiological osteoarthritis increased strongly with age and was highest for cervical spine (peak: men 84.8%, women 84.3%), lumbar spine (peak: 71.9%, women 67.3%), and distal interphalangeal joints of the hands (peak: men 64.4%, women 76%). Prevalence did not exceed 10% in sacroiliac joints, lateral carpometacarpal joints, and tarsometatarsal joints. Severe radiological osteoarthritis (grade 3 or grade 4) was uncommon under age 45; in elderly persons the prevalence of severe radiological osteoarthritis did not exceed 20% except for the cervical and lumbar spine, distal interphalangeal joints of the hands and, in women only, metacarpophalangeal joints, first carpometacarpal joints, first metatarsophalangeal joints, and knees. Overall, differences between men and women were small except for hips and knees; however, severe radiological osteoarthritis was found in a higher proportion in most of the joints in women. Our data were compared with data from similar population surveys. The slope between joint involvement and age was strikingly constant for most of the joints. Differences between populations were mainly differences in level. These differences of prevalence of radiological osteoarthritis may be attributed to interobserver differences--that is, different criteria used to establish radiological osteoarthritis, in addition to genetic or environmental factors, or both.
804 citations
TL;DR: Osteoarthritis is a disease affecting all joint structures, not just hyaline articular cartilage, and it develops as a consequence of injurious activities acting on a vulnerable joint.
511 citations