The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures.
The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures.
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DOI：
10.1007/s00198-006-0211-1
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发表时间：
2007-02
影响因子：
4
通讯作者：
Dixon, T.
中科院分区：
文献类型：
--
作者：
Gallacher, S. J.;Gallagher, A. P.;McQuillian, C.;Mitchell, P. J.;Dixon, T.
尽管椎骨骨折是进一步骨折的重要危险因素，但椎骨骨折通常未被识别。因此，进行了一项研究，以确定出现非椎骨骨折的患者中也有未识别的椎骨骨折的比例。对在南格拉斯哥进行DXA评价的非椎骨骨折患者进行的前瞻性研究，采用椎骨形态测量（MXA），从DV 5/6至LV 4/5。使用Genant半定量分级量表通过直接可视化识别椎体畸形（与骨折一致）。337例低创伤非椎骨骨折患者的数据可用; 261例为女性。在所有患者中，10.4%的患者年龄为50-64岁，53.2%的患者年龄为65-74岁，36.2%的患者年龄为75岁或以上。根据WHO的定义，35.0%的患者腰椎BMD正常（T评分-1或以上），37.4%的患者骨质减少（T评分-1.1至-2.4），27.6%的患者骨质疏松（T评分-2.5或以下）。肱骨（n=103，31%）、尺桡骨（n=90，27%）和手/足（n=53，16%）是最常见的骨折。对于72%的患者（n=241），出现的骨折是第一个引起临床关注的低创伤骨折。通过MXA确定的椎体畸形的总体患病率为25%（n=83）; 45%（n=37）的椎体畸形患者有一个以上椎体的畸形。在椎体畸形和可读扫描分级的患者中，72.5%（58/80）的畸形为2级或3级。髋关节骨折、脊柱T评分≤-2.5、低BMI、或既往有一处以上非椎骨骨折的患者更有可能存在普遍的椎骨畸形（p<0.05）。然而，19.8%的骨质减少T评分患者有椎体畸形（其中48%为多发性），16.1%的T评分正常患者有椎体畸形（其中26.3%为多发性）。在非椎骨骨折后，一些指南建议抗吸收治疗应该保留给DXA证实的骨质疏松症患者。然而，有一个或多个先前椎骨骨折的患者（在非椎骨骨折时普遍存在）也将成为抗吸收治疗的候选者，如果他们的椎骨骨折状态不清楚，情况就不会如此。总体而言，在本研究中，8.9%的患者可能因其潜在的椎体畸形状态而改变治疗。换句话说，11名非椎骨骨折的患者需要进行椎骨形态测量，以确定一名应该进行不同治疗的患者。我们的研究结果支持在经历非椎骨骨折后转诊接受DXA的患者中进行椎骨形态测量的建议。治疗决策将更好地反映任何给定患者未来的绝对骨折风险。如果以这种方式使用椎骨形态测量，则“需要筛选的数量”为7，以识别一名椎骨畸形患者，14，以识别一名具有两个或更多椎骨畸形的患者。虽然进行MXA会增加患者的辐射暴露，但这种增加的暴露量明显低于获得背腰椎X射线的情况。
Despite vertebral fracture being a significant risk factor for further fracture, vertebral fractures are often unrecognised. A study was therefore conducted to determine the proportion of patients presenting with a non-vertebral fracture who also have an unrecognised vertebral fracture. Prospective study of patients presenting with a non-vertebral fracture in South Glasgow who underwent DXA evaluation with vertebral morphometry (MXA) from DV5/6 to LV4/5. Vertebral deformities (consistent with fracture) were identified by direct visualisation using the Genant semi-quantitative grading scale. Data were available for 337 patients presenting with low trauma non-vertebral fracture; 261 were female. Of all patients, 10.4% were aged 50–64 years, 53.2% were aged 65–74 years and 36.2% were aged 75 years or over. According to WHO definitions, 35.0% of patients had normal lumbar spine BMD (T-score −1 or above), 37.4% were osteopenic (T-score −1.1 to −2.4) and 27.6% osteoporotic (T-score −2.5 or lower). Humerus (n=103, 31%), radius–ulna (n=90, 27%) and hand/foot (n=53, 16%) were the most common fractures. For 72% of patients (n=241) the presenting fracture was the first low trauma fracture to come to clinical attention. The overall prevalence of vertebral deformity established by MXA was 25% (n=83); 45% (n=37) of patients with vertebral deformity had deformities of more than one vertebra. Of the patients with vertebral deformity and readable scans for grading, 72.5% (58/80) had deformities of grade 2 or 3. Patients presenting with hip fracture, or spine T-score ≤−2.5, or low BMI, or with more than one prior non-vertebral fracture were all significantly more likely to have evidence of a prevalent vertebral deformity (p<0.05). However, 19.8% of patients with an osteopenic T-score had a vertebral deformity (48% of which were multiple), and 16.1% of patients with a normal T-score had a vertebral deformity (26.3% of which were multiple). Following non-vertebral fracture, some guidelines suggest that anti-resorptive therapy should be reserved for patients with DXA-proven osteoporosis. However, patients who have one or more prior vertebral fractures (prevalent at the time of their non-vertebral fracture) would also become candidates for anti-resorptive therapy—which would have not been the case had their vertebral fracture status not been known. Overall in this study, 8.9% of patients are likely to have had a change in management by virtue of their underlying vertebral deformity status. In other words, 11 patients who present with a non-vertebral fracture would need to undergo vertebral morphometry in order to identify one patient who ought to be managed differently. Our results support the recommendation to perform vertebral morphometry in patients who are referred for DXA after experiencing a non-vertebral fracture. Treatment decisions will then better reflect any given patient’s future absolute fracture risk. The 'Number Needed to Screen' if vertebral morphometry is used in this way would be seven to identify one patient with vertebral deformity, and 14 to identify one patient with two or more vertebral deformities. Although carrying out MXA will increase radiation exposure for the patient, this increased exposure is significantly less than would be obtained if X-rays of the dorso-lumbar spine were obtained.
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