Mechansims and Clinical Importance of Hyperkyphosis:The Framingham Study

描述(由申请人提供)：老年人的后凸畸形是一个重要的、常见的问题，与严重的残疾、发病率和死亡率有关，并将随着人口的老龄化而增加。尽管有公共卫生负担，但没有预防、治疗或管理的指导方针，尽管越来越多的证据表明，有效的干预措施可以减缓进展，甚至改善胸椎后凸。制定预防和治疗后凸畸形的努力的一个关键障碍是缺乏以下方面的信息：(1)女性和男性在整个成年过程中后凸畸形的自然发展史，(2)导致后凸畸形发展的脊柱特征，以及(3)与后凸畸形进展相关的不良健康后果。这个项目非常有意义，因为这项研究的三个目标直接解决了这一知识差距。在Framingham研究中，我们建议对2,000名女性和男性胸椎后凸或Cobb角的6年变化进行纵向研究。首先，我们将确定基线年龄、基线后凸角度和普遍的椎体骨折状态对女性和男性脊柱后凸进展的贡献。其次，我们将确定在女性和男性中，椎间盘高度下降、脊柱肌肉质量下降、小关节骨关节炎进展和脊柱骨折发生率对脊柱后凸进展的贡献。第三，我们将确定女性和男性后凸的进展与肺功能(通过肺活量测定法评估)和身体功能(计时行走、Nagi和Rosow-Breslau评分)下降之间的关系。该项目利用之前在一项以社区为基础的研究中收集的全面、高质量的临床数据，填补了开展预防和治疗后凸畸形并避免进一步的不良健康后果所需的知识的关键空白。研究小组代表了流行病学、生物力学和临床医学方面的专业知识，这是调查这种重大而复杂的疾病所必需的。我们的发现极有可能对临床实践和公众健康产生重大影响。通过确定导致后凸进展的因素和与后凸进展相关的不良健康后果，这项研究将有助于努力确定进展的高风险个体以及预防、治疗和管理的候选人，以避免进一步的疾病负担。 公共卫生相关性：老年人的后凸畸形(胸前弯)是一个重要的、常见的问题，与严重的残疾、发病率和死亡率有关，并将随着人口老龄化而增加。本项目的目的是确定后凸畸形的自然病史、危险因素和临床转归。更好地了解导致后凸发展的因素将有助于采取干预措施来预防和治疗这种复杂的疾病。

DESCRIPTION (provided by applicant): Hyperkyphosis in older adults is an important, common problem, associated with significant disability, morbidity, and mortality, and will increase with the aging of the population. Despite the public health burden, there are no guidelines for prevention, treatment, or management even though there is increasing evidence for effective interventions to reduce progression and even improve thoracic kyphosis. A critical barrier to developing efforts to prevent and treat hyperkyphosis is a lack of information on (1) the natural history of progression of kyphosis in women and men throughout adulthood, (2) the spinal features that contribute to progression, and (3) the adverse health outcomes associated with progression of kyphosis. This project is highly significant, because the 3 aims of this study directly address this gap in knowledge. We propose to conduct a longitudinal study of 6-year change in thoracic kyphosis, or Cobb angle, in 2,000 women and men in the Framingham Study. First, we will determine the contribution of baseline age, baseline kyphosis angle, and prevalent vertebral fracture status to progression of kyphosis in women and men. Second, we will determine the contribution of declines in intervertebral disc height, declines in spinal muscle mass, progression of facet joint osteoarthritis, and incidence of vertebral fracture to progression of kyphosis in women and men. Third, we will determine the association between progression of kyphosis and declines in lung function (assessed by spirometry) and physical function (timed walk, Nagi and Rosow-Breslau scales) in women and men. This project leverages comprehensive, high quality, clinical data, previously collected in a well-characterized community-based study, to fill a critical gap in knowledge required to develop efforts to prevent and treat hyperkyphosis and avoid further adverse health outcomes. The research team represents expertise in epidemiology, biomechanics and clinical medicine necessary to investigate this significant, complex condition. Our findings have a high likelihood of significantly impacting clinical practice and public health. By identifying factors that contribute to progression of kyphosis and adverse health outcomes associated with progression of kyphosis, this study will inform efforts to identify individuals at high risk for progression and candidates for prevention, treatment, and management to avoid further disease burden. PUBLIC HEALTH RELEVANCE: Hyperkyphosis (forward thoracic curvature) in older adults is an important, common problem, associated with significant disability, morbidity, and mortality, and will increase with the aging of the population. The purpose of this project is to determine the natural history, risk factors and clinical outcomes of hyperkyphosis. A greater understanding of the factors that contribute to progression of kyphosis will help lead to interventions to prevent and treat this complex condition.