A&R：老年女性椎间盘间隙狭窄的患病率和严重程度均高于老年男性

椎间盘间隙狭窄是老年人常见的疾病。为研究中国人群中老年人椎间盘狭窄的患病特点，来自香港中文大学和威尔士亲王医院的Yi-Xiang J. Wang博士等人通过一项在老年（>65岁）中国男性（2000例）和中国女性（2000例）的中进行的第一次大规模以人群为基础的骨健康前瞻研究，对香港男性和女性的骨质疏松骨折进行分析。研究者收集并分析这些病例中椎间盘间隙狭窄的患病率，并分析性别、骨密度（BMD）及其他人口统计学和临床数据与椎间盘狭窄的相关性。研究结果发表在2013年4月的ARTHRITIS & RHEUMATISM（关节炎与风湿病）上。研究者发现，中国老年女性椎间盘间隙狭窄的患病率和严重程度均高于老年男性。
研究者根据腰椎侧位平片把L1/L2–L4/L5椎间盘间隙分为4级：0级，正常；1级，轻度狭窄；2级，中度狭窄；4级，中度狭窄。并对人口统计学和临床数据与病例中椎间盘狭窄分级大于3级或小于3级的相关性进行分析。在老年女性中，椎间盘狭窄的患病率较老年男性高。平均值+标准差（mean + SD）女性为2.71 +2.21，女性为3.08 + 2.50（P < 0.0001）。在65–69 岁、70–79 岁及>80 岁三个年龄段中，男性和女性的平均椎间盘间隙狭窄程度均随年龄的增加而增加，而且在女性中增加的程度更大。女性和男性平均椎间盘狭窄评分在三个年龄段的差别分别为0.12、0.40和0.90。在男性和女性中，椎间盘狭窄评级大于3级均与年龄增加、更高的脊柱和髋BMD、下腰背痛和下肢活动受限相关。
老年女性椎间盘间隙狭窄的患病率和严重程度均高于老年男性。随着年龄增加，女性的椎间盘间隙狭窄进展高于男性。椎间盘狭窄评分大于3级与高脊柱和髋BMD相关。
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Prevalence and Sex Difference of Lumbar Disc Space Narrowing in Elderly Chinese Men and Women: Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) Studies
Objective
Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) represent the first large-scale prospective population-based studies on bone health in elderly (age ≥65 years) Chinese men (n = 2,000) and women (n = 2,000). We undertook the current study to investigate the prevalence of lumbar disc space narrowing in these subjects, and to identify the potential relationship between disc space narrowing and sex, bone mineral density (BMD), and other demographic and clinical data.
Methods
On lumbar lateral radiographs, L1/L2–L4/L5 disc space was classified into 4 categories: 0 = normal; 1 = mild narrowing; 2 = moderate narrowing; 3 = severe narrowing. We compared demographic and clinical data between subjects with and those without total disc space narrowing scores ≥3.
Results
Disc space narrowing was more common in elderly women than in elderly men. The mean ± SD disc space narrowing score for the 4 discs was 2.71 ± 2.21 for men and 3.08 ± 2.50 for women (P < 0.0001). For the 3 age groups of 65–69 years, 70–79 years, and ≥80 years, the average disc space narrowing score increased with increasing age in both men and women, and to a greater degree in women than in men. The average disc space narrowing score differences between women and men were 0.12, 0.40, and 0.90, respectively, in the 3 age groups. For both men and women, a disc space narrowing score ≥3 was associated with older age, higher spine and hip BMD, low back pain, and restricted leg mobility.
Conclusion
The prevalence and severity of disc space narrowing are higher in elderly women than in elderly men. With increasing age, disc space narrowing progresses at a greater rate in women than in men. A disc space narrowing score ≥3 is associated with higher spine and hip BMD.