Causes and Consequences of Hyperkyphosis in Older Women

描述（由申请方提供）：过度后凸是指胸椎过度弯曲，通常称为“后凸”。“它经常在老年人中观察到，但对其原因或后果知之甚少。一般认为，但未证实，过度脊柱后凸主要由椎骨骨折引起，尽管先前的小型研究表明骨质疏松症仅占过度脊柱后凸的不到一半。过度后凸的其他潜在原因包括遗传倾向、退行性椎间盘疾病和肌肉无力。过度脊柱后凸与不良结局相关，包括肺功能受限、身体功能差和椎体骨折未考虑的死亡风险增加。这些先前的研究表明，过度脊柱后凸是健康状况不佳的一个重要临床指标。然而，没有一套临床标准来定义什么程度的后凸角构成过度后凸。因此，定义过度脊柱后凸并确定其原因和后果对老年患者的健康具有重要意义。 为了定义过度脊柱后凸，了解其发病机制并了解其健康结果，我们建议使用现有的综合数据集进行一系列分析，即骨质疏松性骨折研究（SOF）。SOF是美国第一个也是最大的前瞻性研究，主要致力于研究老年妇女的骨质疏松性骨折。自1986年以来，参与者参加了骨折和其他慢性疾病风险因素的系列检查。在这项研究中，我们建议从现有的基线X线片和基线后平均3.5年和15年的重复X线片测量后凸角。我们创建了一个数字化程序，计算最广泛使用的脊柱后凸的放射学测量，Cobb角。因此，可以以最小的努力在大量受试者中进行可靠的测量。利用来自SOF的现有数据，我们将：1）量化1000名老年妇女的后凸角，并确定有多少过度后凸角是由于潜在的骨质疏松症，有多少与其他潜在的风险因素有关，包括遗传易感性，肌无力，椎间盘高度损失和健康行为;和2）通过与重要结局（包括福尔斯、骨折和功能限制）的相关性，确定什么程度的后凸角构成过度后凸。这是第一次对过度脊柱后凸的原因和后果进行全面的研究。这种对现有数据集的成本效益高和创新性的使用很可能产生对这种常见情况的第一次系统分析。

DESCRIPTION (provided by applicant): Hyperkyphosis refers to an excessive curvature of the thoracic spine, commonly known as the "Dowagers hump." It is frequently observed in the older population, and yet little is known about its causes or consequences. It is generally assumed, but not proven, that hyperkyphosis primarily results from vertebral fractures, although previous small studies suggest that osteoporosis only accounts for less than half of hyperkyphosis. Potential other causes of hyperkyphosis include a genetic predisposition, degenerative disc disease, and muscular weakness. Hyperkyphosis is associated with adverse outcomes including restricted pulmonary function, poor physical function, and an increased risk of mortality that is not accounted for by vertebral fractures. These previous studies suggest that hyperkyphosis is an important clinical indicator of poor health. However, there are no set clinical criteria that define what degree of kyphotic angle constitutes hyperkyphosis. Therefore, defining hyperkyphosis and determining its causes and consequences has important implications for the health of older patients. To define hyperkyphosis, understand its pathogenesis and learn its health outcomes, we propose to conduct a series of analyses using an existing comprehensive data set, the Study of Osteoporotic Fractures (SOF). SOF is the first and largest prospective U.S. study devoted primarily to the study of osteoporotic fractures in older women. Since 1986, participants have attended serial exams of risk factors for fractures and other chronic diseases. In this study, we propose to measure the kyphotic angle from existing baseline radiographs and from repeated radiographs taken an average of 3.5 and 15 years after baseline. We created a digitization program that calculates the most widely used radiological measure of kyphosis, the Cobb angle. Thus, a reliable measure can be made in a large number of subjects with minimal effort. Using existing data from SOF, we will: 1) quantify the kyphotic angle in 1000 older women and determine how much of hyperkyphosis is due to underlying osteoporosis and how much is related to other potential risk factors including a genetic predisposition, muscle weakness, intervertebral disc height loss, and health behaviors; and 2) define what degree of kyphoUc angle constitutes hyperkyphosis by its association with important outcomes including falls, fractures, and functional limitations. This is the first comprehensive study of the causes and consequences of hyperkyphosis. This cost-effective and innovative use of an existing data set is likely to produce the first systematic analyses of this common condition.