BIOLOGICAL AND STRUCTURAL PREDICTORS OF KYPHOSIS PROGRESSION IN OLDER MEN

描述（由申请人提供）：后凸畸形（HK）或胸椎曲度加重，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，大多数人都认为香港主要影响老年妇女。我们的初步研究结果表明，老年男性遭受与年龄相关的姿势变化的可能性至少与老年女性一样大，而且与女性相比，男性可能面临更大的不利健康后果风险，如跌倒和过早死亡。在过去的6年里，我们的研究团队在了解老年女性HK的流行病学方面做出了重大贡献。我们证明，年龄、椎体骨折和低骨密度只能解释一小部分后凸进展的差异，其他导致HK的重要因素包括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，通过研究发现，老年HK女性未来骨折、功能下降和早期死亡的风险增加，我们最近将HK确立为一种新的女性老年综合征。目前，对男性HK的研究较少。为了更好地识别男性HK并从发病机制和健康结果方面了解其流行病学，美国国立卫生研究院（NIH）通过“主任桥奖”（Director's Bridge Award）向首席研究员提供资金，根据现有基线和平均4.6年后从男性骨质疏松性骨折（MrOS）研究中获得的侧位脊柱x线片，对1800名老年男性的胸后凸进行测量。mri是美国第一个也是最大的前瞻性研究，主要致力于男性骨质疏松性骨折的调查，它将很快有金标准后凸测量可用于调查。剩下的就是获得必要的资金，以支持研究者和分析师有时间完成对这些老年人的二次分析。随着美国国立卫生研究院对获得金标准后凸测量的投资，这个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后凸进展的生物学和结构相关因素；2)能够确定与临床相关的HK程度；3)告知如何防止其发展的策略。如果得到资助，我们的研究有望产生重要的发现，可能会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视为一种被接受的、很少被谈论的与年龄有关的现象；对其在男性中的生物学和结构相关性的彻底调查应该为治疗策略提供重要的见解。)

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.