Hyperkyphosis and mortality risk in older men: The osteoporotic fractures in men study.
Hyperkyphosis and mortality risk in older men: The osteoporotic fractures in men study.
复制标题
老年男性的后凸畸形和死亡风险：男性骨质疏松性骨折研究。
DOI：
10.1111/jgs.18100
复制
发表时间：
2023
影响因子：
6.3
通讯作者：
Kado,DeborahM
中科院分区：
文献类型：
--
作者：
Cours,Alexandra;Huang,Mei-Hua;Fink,Howard;Ensrud,KristineE;Schousboe,JohnT;Katzman,Wendy;Schneider,Diane;Lane,NancyE;Cawthon,Peggy;Kado,DeborahM
脊柱后凸症通常影响老年人，但不被广泛认为是一个临床可操作的问题，特别是在男性中。有几种量化后凸的技术，包括骨块和Cobb角测量。这项研究包括两种后凸测量，以调查老年男性后凸加重是否可能增加死亡风险。方法招募年龄≥65岁的男性（N= 5994）参加2000 - 2002年（基线）的mrs前瞻性队列研究。我们的主要队列包括2931名入组者（平均年龄79.3岁，SD 5.2），他们在2006年至2009年间经历了阻滞测量的后凸。我们的第二队列包括2351名在基线时接受放射科布角测量的参与者。Cox比例风险分析用于确定后凸与全因死亡率之间的关系，同时调整了常见的椎体骨折、骨密度、意外骨折、步态速度、定时站立椅、自我报告的健康状况、酒精使用、医疗合并症和身体活动。结果在平均8.3年（SD 3.2）的随访期间，主要队列中有1393名参与者死亡。在该组中，与0-1阻滞后凸的男性相比，阻滞测量后凸的增加与死亡率增加相关（HR: 1.26-1.53，p趋势<0.001）。在调整后的模型中加入了普遍的椎体骨折，在严重后凸（3+块测量）的参与者中，相关性仍然显著。同样地，在椅子站立的情况下，4个街区以上的后凸仍有显著的相关性。步行速度并没有减弱后凸和死亡率的相关性。在第二个队列中，放射科布角后凸与死亡率之间没有显著关联。结论：在老年男性中，增加的阻滞测量的后凸与更高的死亡风险相关，表明在体检中发现的后凸过度应被视为具有临床意义的发现，可能需要进一步的评估和治疗。
IntroductionHyperkyphosis commonly affects older people but is not widely acknowledged as a clinically actionable problem, especially in men. There are several techniques to quantify kyphosis including the blocks and Cobb angle measurements. This study includes both kyphosis measures to investigate whether older men with accentuated kyphosis may be at increased mortality risk.MethodsMen aged ≥65 years (N= 5994) were recruited to participate in the MrOS prospective cohort study from 2000 to 2002 (baseline). Our primary cohort included 2931 enrollees (mean age 79.3 years; SD 5.2) who underwent blocks‐measured kyphosis from 2006 to 2009. Our secondary cohort included 2351 participants who underwent radiographic Cobb angle measurements at baseline. Cox proportional hazards analyses were used to determine association between kyphosis and all‐cause mortality while adjusting for prevalent radiographic vertebral fractures, bone mineral density, incident fractures, gait speed, timed chair stands, self‐reported health, alcohol use, medical co‐morbidities, and physical activity.ResultsDuring a mean follow‐up of 8.3 (SD 3.2) years, 1393 participants died in the primary cohort. In this group, compared to men with 0–1 block kyphosis, increasing blocks‐measured kyphosis was associated with increased mortality (HR: 1.26–1.53,ptrend <0.001). With addition of prevalent vertebral fracture to adjusted models, the association remained significant in participants with severe kyphosis (3+ blocks‐measured). Similarly, with addition of chair stand performance the association remained significant for 4+ blocks kyphosis. Walking speed did not attenuate the association of kyphosis and mortality. In the secondary cohort, there were no significant associations between radiographic Cobb angle kyphosis and mortality.ConclusionsIncreasing blocks‐measured kyphosis was associated with a greater risk of mortality in older men, indicating that hyperkyphosis identified on physical exam should be considered a clinically significant finding that may warrant further evaluation and treatment.