Abstract
Objectives. To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time. Methods. In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature. Results. Images from 10 132 participants (56% female, mean age 63.9 years) passed quality checks. Overall, 47% of men and women had DDD grade 3 or more in the lumbar spine and 36% in both thoracic and lumbar spine. Risk ratios for DDD grades 3 and 4, adjusted for age and anthropometric determinants, varied across a three-fold range between centres, yet prevalences were highly correlated in men and women. DDD was associated with flattened, non-ovoid inter-vertebral disc spaces. KL grade 4 and loss of inter-vertebral disc space were associated with higher spine aBMD. Conclusion. KL grades 3 and 4 are often used clinically to categorize radiological DDD. Highly variable European prevalences of radiologically defined DDD grades 3+ along with the large effects of age may have growing and geographically unequal health and economic impacts as the population ages. These data encourage further studies of potential genetic and environmental causes.
| Original language | English |
|---|---|
| Journal | Rheumatology (United Kingdom) |
| Volume | 56 |
| Issue number | 7 |
| Pages (from-to) | 1189-1199 |
| Number of pages | 11 |
| ISSN | 1462-0324 |
| DOIs | |
| Publication status | Published - 01.07.2017 |
Funding
The acquisition of the images for this study was financially supported by a European Union Concerted Action Grant under Biomed-1 (BMH1CT920182), and also EU grants C1PDCT925102, ERBC1PDCT 930105 and 940229. The central co-ordination for the data acquisition phase was also supported by the UK Arthritis Research Campaign, the Medical Research Council (G9321536), the UK National Osteoporosis Society and the European Foundation for Osteoporosis and Bone Disease. The EU's PECO program linked to BIOMED 1 funded in part the participation of the Budapest, Warsaw, Prague, Piestany, Szczecin and Moscow centres. The central radiological evaluation for vertebral fracture was sponsored by the Bundesministerium fur Forschung and Technologie, Germany. The radiological evaluations for other radiological aspects of this study were undertaken as part of a PhD studentship (to M.G.) and otherwise it was undertaken without external financial support. J.R., C.C. and K.J. acknowledge the support of the NIHR to the Biomedical Research Unit in Musculoskeletal Disease at the Botnar Research Centre, Oxford. T.O.N. and M.L. acknowledge the support of the NIHR to the Manchester Musculoskeletal Biomedical Research Unit, Manchester. Individual centres acknowledge the receipt of locally acquired support for their data collection. We thank the thousands of individuals who took part in the study and the many other individuals who helped access our population samples. Principal Investigators of the centres participating in both the EVOS and EPOS Study Groups: D. M. Reid, Aberdeen, UK; G. Lyritis, Athens, Greece; A. K. Bhalla, Bath, UK; D. Felsenberg, D. Banzer and W. Reisinger, Berlin, Germany; H. Schatz, Bochum, Germany; G. Poor, Budapest, Hungary; C. J. Todd, Cambridgeshire UK; G. Kragl, Erfurt, Germany; K. Weber, Graz, Austria; J. Reeve, Harrow, UK; C. Scheidt-Nave, Heidelberg, Germany; K. Abendroth, Jena, Germany; J. Dequeker, Leuven, Belgium; P. D. Delmas (deceased), Lyon, France; H. Raspe, Lubeck, Germany; O. Johnell (deceased), Malmo, Sweden; T. W. O'Neill, Manchester, UK; L. I. Benevolenskaya, Moscow, Russia; A. Aroso, Oporto, Portugal; J. Cannata, Oviedo, Spain; P. Masaryk, Piestany, Slovakia; S. Havelka (deceased), Prague, Czech Republic; H. Pols, Rotterdam, Netherlands; R. Nuti, Siena, Italy; T. Miazgowski, Szczecin, Poland; A. D. Woolf, Truro, UK; K. Hoszowski, Warsaw, Poland; O. Yershova, Yaroslavl, Russia; I. Jajic (deceased), Zagreb, Croatia. No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript.
