The Importance of Identifying Osteoporotic Vertebral Deformity (VD) with Endplate/Cortex Fracture (ECF) in Elderly Chinese Men and Women: Results of Mr.OS and MsOS Hong Kong Studies

• Main Author: Nordin, Mohd Nazmi Bin Che
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2020
• Subjects: Aging; Asian Studies; Medical imaging
• ISBN: 9798379550400

It is important to clearly identify and accurately report osteoporotic vertebral fractures (VFs), so that appropriate investigation and treatment can be commenced. In the first study, T4–L4 radiographs of 1,954 and 1,953 elderly Chinese men and women above 65 years old were evaluated to identify anatomical location of EPF. There were 505 EPFs (males: 27.7%; females: 72.3%) identified from the 101,582 endplates analyzed. Excluding those with both upper endplate (uEP) and lower endplate (lEP) involvements, the ratio of uEP to lEP was 9.63 for males and 4.3 for females (P<0.05). Highest prevalence of EPF occurs at thoracolumbar junction, particularly L1 (males: 26.4%; females: 24.1%) and followed by T12 (males: 20.7%; females: 19.7%). Osteoporotic EPFs are more likely involve the upper endplate rather than lower endplate, and is greater in men than in women. The second study was a year-4 radiographic follow-up (FU) of Ms.OS (Hong Kong) study. The study subjects included 1533 females with baseline and year-4 FU (mean age 75.7 years), were evaluated according to Genant’s VD and ECF criteria. Subjects were graded into seven categories: VD0/ECF0, VD1/ECF0, VD2m/ECF0, VD1/ECF1, VD2m/ECF1, VD2s/ECF1, and VD3/ECF1. With an existing VD, a further height loss of ≥15% was a VD progression. A new VD incident was a change from grade 0 to grade 2/3, or to grade 1 with ≥10% height loss. At FU, female subjects with Genant’s grades-0,-1, -2, and -3 VD (4.6%, 8%, 10.6%, and 28.9%) had at least one VD progression/new incident VD respectively. Among the three ECF0 groups, there was no difference in VD progression/new VD; while there was a significant difference in new ECF incidence, with VD0/ECF0 being lowest and VD2m/ECF0 being highest. VD1/ECF0 and VD2m/ECF0 vertebrae had a higher risk of turning to ECF1 than VD0/ECF0 vertebrae. The third study was a year-4 radiographic FU of Mr.OS (Hong Kong) study. 1500 Chinese males with baseline (mean age 71.7 years, range 65–91 years) and year4 FU were evaluated according to Genant’s VD and ECF criteria. Subjects were graded into eight categories: VD0/ECF0, VD1/ECF0, VD2m/ECF0, VD0/ECF1, VD1/ECF1, VD2m/ECF1, VD2s/ECF1, and VD3/ECF1. With an existing VD, a further height loss of ≥15% was a VD progression. A new VD incident was a change from grade 0 to grade 2/3, or to grade 1 with ≥10% height loss. Of subjects with Genant’s grade 0 (2.05%), grade 1 (2%), grade 2 (3.1%), and grade 3 (2.8%) VD had at least one VD progression or/and new VD. Among the three ECF0 groups, there was a significant difference in new ECF incidence, with VD0/ECF0 being the lowest and VD2m/ECF0 being the highest. VD progression/new VD is much less common in elderly men than in elderly women. Vertebrae with VD had a higher risk of developing ECF. The fourth study was about detecting moderate and severe grades VD on frontal radiograph (FR). There were 105 female cases (mean: 72 years) who were referred for digital spine FR and lateral radiograph (LR) with back and/or leg pain. Both LR and FR were read, with <20%, 20-25%, 25-40%, and >40% vertebral body height loss were recorded as minimal, mild, moderate, and severe grades, respectively. Only FRs were read again after 10 months’ interval. Each vertebra was classified as (1) no notable VD, (2) with notable VD, (3) ambiguous, while allowing to miss minimal/mild VCD and ECF. Counting by subjects, for 98 cases the two reading sessions had agreement, including 43 ‘true negative’ cases and 55 true positive cases. There were two false positive cases, and five ambiguous cases. Altogether 1286 vertebra were assessed on FR had 1126 vertebrae ‘true negative’, 130 true positive, 1 false negative, 3 false positive, and 26 ambiguous vertebrae (65.4% true negative and 34.6% true positive). Moderate and severe grades of VD are identifiable on FR as long as the involved vertebrae are clearly filmed.