BIOLOGICAL AND STRUCTURAL PREDICTORS OF KYPHOSIS PROGRESSION IN OLDER MEN

描述（由申请人提供）：过度后凸（HK）或胸椎弯曲加重，影响多达20%至40%的老年人，使其成为严重的公共卫生问题。直到最近，大多数人都认为HK主要影响老年女性。我们的初步研究结果表明，老年男性至少与老年女性一样可能遭受与年龄相关的姿势变化，与女性相比，男性可能面临更大的不良健康后果风险，如福尔斯和过早死亡。在过去的6年里，我们的研究团队对了解老年妇女中的HK流行病学做出了重大贡献。我们证明年龄、椎体骨折和低骨密度仅能解释后凸进展的一小部分变异，导致HK的其他重要因素包括HK家族史、早期和持续的身高下降、体重下降和整体椎体压缩和椎间盘高度下降。此外，通过显示老年女性HK未来骨折、功能下降和早期死亡的风险增加，我们最近将HK确定为一种新的女性老年综合征。目前，很少有研究在男性中调查HK。 为了开始应对更好地识别男性HK并了解其发病机制和健康结果方面的流行病学的挑战，NIH通过主任桥梁奖，已经为主要研究者提供了资金，以测量1，800名老年男性现有的基线和随访侧位脊柱X线片，平均4.6年后从男性骨质疏松性骨折（MrOS）研究。MrOS是美国第一个也是最大的前瞻性研究，主要致力于研究男性脊柱后凸骨折，它很快就会有金标准脊柱后凸测量可用于研究。剩下的就是获得必要的资金，以支持研究人员和分析人员完成这些老年男性的二次分析。随着NIH对获得黄金标准脊柱后凸测量的投资，这一丰富的数据集提供了无与伦比的机会：1）更好地了解导致老年男性脊柱后凸进展的生物学和结构相关性; 2）能够定义临床相关的HK程度; 3）告知如何预防其进展的策略。如果获得资助，我们的研究有望产生重要的发现，可能导致老年男性与年龄相关的姿势变化概念化的范式转变。目前的临床实践将男性HK视为一种公认的且很少谈论的年龄相关现象;对其在男性中的生物学和结构相关性的彻底调查应提供重要的见解，以告知治疗策略。

DESCRIPTION (provided by applicant): Hyperkyphosis (HK), or accentuated thoracic spinal curvature, affects as many as 20% to 40% of older adults, making it a serious public health problem. Until recently, most people have assumed that HK affects predominantly older women. Our preliminary research findings demonstrate that older men are at least as likely as older women to suffer from age-related postural changes and that compared with women, men may be at even greater risk of adverse health outcomes such as falls and earlier mortality. In the past 6 years, our research team has made significant contributions towards understanding the epidemiology of HK in older women. We demonstrated that age, vertebral fractures and low bone mineral density only explain a small fraction in the variance of kyphosis progression and that other important factors leading to HK include a family history of HK, early and ongoing height loss, weight loss, and overall vertebral body compression and disc height loss. In addition, by also showing that older women with HK are at increased risk of future fractures, functional decline, and earlier mortality, we have recently established HK as a new female geriatric syndrome. Currently, there are few studies that have investigated HK in men. To begin to address the challenge of better identifying male HK and understanding its epidemiology in terms of pathogenesis and health outcomes, the NIH, through the Director's Bridge Award, has already provided the principal investigator with funding to measure thoracic kyphosis in 1,800 older men from existing baseline and follow-up lateral spine radiographs taken an average of 4.6 years later from the Osteoporotic Fractures in Men (MrOS) Study. MrOS is the first and largest prospective U.S. study devoted primarily to the investigation of osteoporotic fractures in men and it will soon have the gold standard kyphosis measurement available for investigation. All that remains is to obtain the necessary funding to support investigator and analyst time to complete secondary analyses in these older men. With the NIH's investment in obtaining the gold standard kyphosis measurement, this enriched data set confers an unparalled opportunity to: 1) better understand the biological and structural correlates leading to kyphosis progression in older men; 2) be able to define the degree of HK that is clinically relevant; and 3) inform strategies on how to prevent its progression. If funded, our research promises to yield important findings that may lead to a paradigm shift in the conceptualization of age-related postural changes in older men. Current clinical practice views male HK as an accepted and little talked about age-related phenomena; a thorough investigation of its biological and structural correlates in men should provide important insights to inform treatment strategies.)