BIOLOGICAL AND STRUCTURAL PREDICTORS OF KYPHOSIS PROGRESSION IN OLDER MEN

老年男性脊柱后凸进展的生物学和结构预测因素

• 批准号: 8083449
• 负责人: Deborah Kado
• 金额: $ 35.53万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8083449
• 关键词: Abdomen; Address; Adipose tissue; Affect; Age; Anatomic Models; Anatomy; Anterior; Biological; Body Weight Changes; Body Weight decreased; Bone Density; Chest; Clinical; Communities; Complex; Coupled; Data Analyses; Data Set; Development; Disease; Elderly; Epidemiology; Family history of; Female; Fracture; Funding; Future; Gold; Gonadal Steroid Hormones; Health; Height; Howard Temin Award; Hyperkyphosis; Investigation; Investments; Kyphosis deformity of spine; Lateral; Lead; Measurement; Measures; Obesity; Osteoporosis; Outcome; Pathogenesis; Physical Function; Population; Principal Investigator; Public Health; Reporting; Research; Research Personnel; Resources; Risk; Sampling; Skeletal Muscle; Spinal; Spinal Curvatures; Spinal Fractures; Syndrome; Time; United States National Institutes of Health; Vertebral column; Vitamin D; Woman; Work; age related; clinical practice; clinically relevant; disability; fall risk; falls; follow-up; functional decline; insight; male; men; mortality; muscle form; older men; older women; osteoporosis with pathological fracture; prevent; prospective; standard measure; treatment strategy; vertebra body

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.) PUBLIC HEALTH RELEVANCE: Osteoporosis and hyperkyphosis (commonly known as the dowager's hump) are complex disorders that although related, are distinct entities that until now have been assumed to be the same. While also thought to affect predominantly older women, recent studies demonstrate that hyperkyphosis also commonly affects older men, and that in comparison with women, men with hyperkyphosis may suffer from even worse health consequences. This project will investigate the biological and structural predictors of kyphosis progression assessed over an average of 4.6 years, and determine what degree of kyphosis indicates a pathological condition in a large population of 1,800 older community-dwelling men.

描述(申请人提供)：脊柱后凸(HK)，或称胸椎弯曲加重，影响多达20%至40%的老年人，使其成为一个严重的公共卫生问题。直到最近，大多数人还认为香港影响的主要是老年女性。我们的初步研究结果表明，老年男性至少与老年女性一样有可能遭受与年龄相关的姿势变化，而且与女性相比，男性可能面临更大的不利健康后果的风险，如摔倒和更早死亡。在过去的6年里，我们的研究团队为了解老年妇女感染香港的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只能解释脊柱后凸进展的一小部分差异，而导致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、整体椎体压缩和椎间盘高度下降。此外，通过还表明患有HK的老年女性未来骨折、功能衰退和更早死亡的风险增加，我们最近将HK确立为一种新的女性老年综合征。目前，很少有研究对男性的HK进行研究。为了开始应对更好地识别男性HK并从发病机制和健康结果方面了解其流行病学方面的挑战，NIH已通过主任桥梁奖向首席研究员提供资金，以测量1,800名老年男性的胸椎后凸畸形，从现有的基线和平均4.6年后从骨质疏松性男性骨折(MROS)研究中获得的后续侧位脊柱X线片。MROS是美国第一项也是最大规模的前瞻性研究，主要致力于男性骨质疏松性骨折的调查，不久将有黄金标准的脊柱后凸测量用于研究。剩下的就是获得必要的资金，以支持研究人员和分析师有时间完成对这些老年男性的二次分析。随着美国国立卫生研究院在获得黄金标准脊柱后凸测量方面的投资，这一丰富的数据集提供了一个无与伦比的机会：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)能够定义与临床相关的HK程度；以及3)提供如何防止其进展的策略。如果得到资助，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。目前的临床实践认为男性HK是一种被接受的、很少被谈论的与年龄相关的现象；对男性的生物学和结构相关性的彻底调查应该会为治疗策略提供重要的见解。) 公共卫生相关性：骨质疏松症和后凸过度(通常被称为老年驼峰)是复杂的疾病，虽然相关，但它们是不同的实体，直到现在一直被认为是相同的。虽然也被认为主要影响老年女性，但最近的研究表明，过度后凸通常也会影响老年男性，与女性相比，患有过度后凸的男性可能会遭受更严重的健康后果。该项目将调查生物学和结构上预测脊柱后凸进展的因素，对平均4.6年的时间进行评估，并确定在1800名居住在社区的老年男性中，脊柱后凸在多大程度上表明是一种病理状态。