Mechansims and Clinical Importance of Hyperkyphosis:The Framingham Study

描述（由申请人提供）：老年人后凸过度是一个重要的、常见的问题，与显著的残疾、发病率和死亡率相关，并将随着人口老龄化而增加。尽管存在公共卫生负担，但没有预防、治疗或管理的指南，尽管有越来越多的证据表明有效的干预措施可以减少进展甚至改善胸后凸。预防和治疗后凸过度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期后凸进展的自然史，(2)导致后凸进展的脊柱特征，以及(3)与后凸进展相关的不良健康结果。这个项目非常重要，因为本研究的三个目标直接解决了这一知识差距。我们建议在Framingham研究中对2000名男性和女性进行为期6年的胸部后凸或Cobb角变化的纵向研究。首先，我们将确定基线年龄、基线后凸角度和普遍椎体骨折状态对女性和男性后凸进展的影响。其次，我们将确定椎间盘高度下降、脊柱肌肉质量下降、小关节骨性关节炎进展和椎体骨折发生率对男女后凸症进展的影响。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（定时行走、Nagi和Rosow-Breslau量表）下降之间的关系。该项目利用了以前在一项特征明确的社区研究中收集的全面、高质量的临床数据，以填补预防和治疗后凸过度和避免进一步不良健康后果所需的知识空白。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，需要调查这一重大而复杂的疾病。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。通过确定导致后凸症进展的因素和与后凸症进展相关的不良健康结果，本研究将为确定高风险的进展个体和预防、治疗和管理候选人提供信息，以避免进一步的疾病负担。

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.