G Armbrecht1, D Felsenberg1, M Ganswindt1, M Lunt2, S K Kaptoge3, K Abendroth4, A Aroso5, D Banzer6, A K Bhalla7, J Dequeker8, R Eastell9, K Hoszowski10, G Lyritis11, P D Delmas12, P Masaryk13, T Miazgowski14, J Cannata15, R Nuti16, L Oei17, G Poor18, I Redlund-Johnell19, D M Reid20, W Reisinger21, H Schatz22, C J Todd3,23, A D Woolf24, K Javaid25, F Rivadeneira17, A J Silman2,26, C Cooper25, T W O'Neill2, J Reeve27. 1. Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany. 2. ARC Epidemiology Unit, University of Manchester Musculoskeletal Biomedical Research Unit & Arthritis Research UK Centre for Epidemiology, Manchester, UK. 3. Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK. 4. Klinik fur Innere Medezin IV, Jena, Germany. 5. Hospital de San Joao, Oporto, Portugal. 6. Röntgen u Nuklearmed, Krankenhaus Behring, Berlin, Germany. 7. Royal National Hospital for Rheumatic Diseases, Bath, UK. 8. University Hospital, Leuven, Belgium. 9. Department of Human Metabolism, University of Sheffield, Sheffield, UK. 10. PKP Hospital, Warsaw, Poland. 11. Laboratory for Research on the Musculoskeletal System, University of Athens, Athens, Greece. 12. Centre de Médécine Specialisée Claude Gauthier, Montceau-les-Mines France & U Inserm 504, Lyon, France. 13. Institute of Rheumatic Diseases, Piestany, Slovakia. 14. Department of Hypertension, Pomeranian Medical University, Szczecin, Poland. 15. Asturias General Hospital, Oviedo, Spain. 16. Institute of Clinical Medicine, University of Siena, Siena, Italy. 17. Departments of Epidemiology and Internal Medicine, Erasmus University, Rotterdam, Netherlands. 18. National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. 19. Orthopaedics and Radiology, Malmö General Hospital, Malmö, Sweden. 20. School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK. 21. Charité Inst fur Rontgendiagnostik, Berlin, Germany. 22. Med Klinik & Polyklinik Bochum, Bochum, Germany. 23. School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK. 24. Royal Cornwall Hospital, Truro, UK. 25. NIHR Musculo-skeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre & Institute of Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK. 26. Arthritis Research UK, Chesterfield, S41 7TD, UK. 27. NIHR Musculo-skeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre & Institute of Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK. jonathan.reeve@ndorms.ox.ac.uk.
Abstract
UNLABELLED: In 27 centres across Europe, the prevalence of deforming spinal Scheuermann's disease in age-stratified population-based samples of over 10,000 men and women aged 50+ averaged 8% in each sex, but was highly variable between centres. Low DXA BMD was un-associated with Scheuermann's, helping the differential diagnosis from osteoporosis. INTRODUCTION: This study aims to assess the prevalence of Scheuermann's disease of the spine across Europe in men and women over 50 years of age, to quantitate its association with bone mineral density (BMD) and to assess its role as a confounder for the radiographic diagnosis of osteoporotic fracture. METHODS: In 27 centres participating in the population-based European Vertebral Osteoporosis Study (EVOS), standardised lateral radiographs of the lumbar and of the thoracic spine from T4 to L4 were assessed in all those of adequate quality. The presence of Scheuermann's disease, a confounder for prevalent fracture in later life, was defined by the presence of at least one Schmorl's node or irregular endplate together with kyphosis (sagittal Cobb angle >40° between T4 and T12) or a wedged-shaped vertebral body. Alternatively, the (rare) Edgren-Vaino sign was taken as diagnostic. The 6-point-per-vertebral-body (13 vertebrae) method was used to assess osteoporotic vertebral shape and fracture caseness. DXA BMD of the L2-L4 and femoral neck regions was measured in subsets. We also assessed the presence of Scheuermann's by alternative published algorithms when these used the radiographic signs we assessed. RESULTS: Vertebral radiographic images from 4486 men and 5655 women passed all quality checks. Prevalence of Scheuermann's varied considerably between centres, and based on random effect modelling, the overall European prevalence using our method was 8% with no significant difference between sexes. The highest prevalences were seen in Germany, Sweden, the UK and France and low prevalences were seen in Hungary, Poland and Slovakia. Centre-level prevalences in men and women were highly correlated. Scheuermann's was not associated with BMD of the spine or hip. CONCLUSIONS: Since most of the variation in population impact of Scheuermann's was unaccounted for by the radiological and anthropometric data, the search for new genetic and environmental determinants of this disease is encouraged.
UNLABELLED: In 27 centres across Europe, the prevalence of deforming spinal Scheuermann's disease in age-stratified population-based samples of over 10,000 men and women aged 50+ averaged 8% in each sex, but was highly variable between centres. Low DXA BMD was un-associated with Scheuermann's, helping the differential diagnosis from osteoporosis. INTRODUCTION: This study aims to assess the prevalence of Scheuermann's disease of the spine across Europe in men and women over 50 years of age, to quantitate its association with bone mineral density (BMD) and to assess its role as a confounder for the radiographic diagnosis of osteoporotic fracture. METHODS: In 27 centres participating in the population-based European Vertebral Osteoporosis Study (EVOS), standardised lateral radiographs of the lumbar and of the thoracic spine from T4 to L4 were assessed in all those of adequate quality. The presence of Scheuermann's disease, a confounder for prevalent fracture in later life, was defined by the presence of at least one Schmorl's node or irregular endplate together with kyphosis (sagittal Cobb angle >40° between T4 and T12) or a wedged-shaped vertebral body. Alternatively, the (rare) Edgren-Vaino sign was taken as diagnostic. The 6-point-per-vertebral-body (13 vertebrae) method was used to assess osteoporotic vertebral shape and fracture caseness. DXA BMD of the L2-L4 and femoral neck regions was measured in subsets. We also assessed the presence of Scheuermann's by alternative published algorithms when these used the radiographic signs we assessed. RESULTS: Vertebral radiographic images from 4486 men and 5655 women passed all quality checks. Prevalence of Scheuermann's varied considerably between centres, and based on random effect modelling, the overall European prevalence using our method was 8% with no significant difference between sexes. The highest prevalences were seen in Germany, Sweden, the UK and France and low prevalences were seen in Hungary, Poland and Slovakia. Centre-level prevalences in men and women were highly correlated. Scheuermann's was not associated with BMD of the spine or hip. CONCLUSIONS: Since most of the variation in population impact of Scheuermann's was unaccounted for by the radiological and anthropometric data, the search for new genetic and environmental determinants of this disease is encouraged.
Entities:
Keywords:
Bone mineral density; Fracture; Osteoporosis; Scheuermann’s disease
Authors: Matthew A Halanski; Blake Hildahl; Laura A Amundson; Ellen Leiferman; Annette Gendron-Fitzpatrick; Rajeev Chaudhary; Heather M Hartwig-Stokes; Ronald McCabe; Rachel Lenhart; Matthew Chin; Jennifer Birstler; Thomas D Crenshaw Journal: J Bone Joint Surg Am Date: 2018-03-07 Impact factor: 5.284
Authors: Gabriele Armbrecht; Dieter Felsenberg; Melanie Ganswindt; Mark Lunt; Stephen K Kaptoge; Klaus Abendroth; Antonio Aroso Dias; Ashok K Bhalla; Jorge Cannata Andia; Jan Dequeker; Richard Eastell; Krzysztof Hoszowski; George Lyritis; Pavol Masaryk; Joyce van Meurs; Tomasz Miazgowski; Ranuccio Nuti; Gyula Poór; Inga Redlund-Johnell; David M Reid; Helmut Schatz; Christopher J Todd; Anthony D Woolf; Fernando Rivadeneira; Muhammad K Javaid; Cyrus Cooper; Alan J Silman; Terence W O'Neill; Jonathan Reeve Journal: Rheumatology (Oxford) Date: 2017-07-01 Impact factor: 7.580