Vertebral deformation in spinal osteoporosis results in spinal and thoracic deformation, causing pain, disability and an overall decrease in quality of life. We sought to determine whether thoracic spinal deformation may lead to impaired pulmonary function. We studied expiratory relaxed vital capacity (VC) and forced expiratory volume in 1 s (FEV1) in 34 patients with spinal osteoporotic fractures and 51 patients with chronic low back pain (CLBP) due to reasons other than osteoporosis. Measurements of pulmonary function tests were calculated as a percentage of the normal range adjusting for age, sex, and height using the equations for normal values of the EKGS (Europäische Gesellschaft für Kohle und Stahl). Severity of osteoporosis was determined by calculation of the spine deformity index (SDI-total and SDI-anterior) on lateral radiographs of the spine and clinical measures of body stature (height reduction, distance from lowest ribs to iliac crest and distance from the occiput to the wall). Patients with osteoporosis had a lower vital capacity (%VC of the reference value) than patients with CLBP. The differences were more prominent (p < 0.05) when the previous body height, at age 25 years, was used as reference for calculation of VC (mean +/- SD: 93.6% +/- 15.3% in patients with osteoporosis v 105.6% +/- 15.1% in patients with CLBP). FEV1 was significantly (p < 0.05) lower in patients with osteoporosis when previous body height was considered, in comparison with patients with CLBP (mean +/- SD: 85.0% +/- 14.2% in patients with osteoporosis v 92.4% +/- 13.6% in patients with CLBP). In patients with osteoporosis VC (standardized on previous body height) was significantly negatively correlated with SDI-anterior (r = -0.4, p < 0.03). Furthermore, VC standardized on previous body height showed a weak but significant negative correlation with some clinical measures of osteoporosis (height reduction vs %VC: r = -0.34, p < 0.05; distance from the lowest ribs to iliac crest vs %VC: r = 0.35, p < 0.04). In conclusion, we found that pulmonary function is significantly diminished in patients with spinal osteoporotic fractures as compared with CLBP patients without evidence of manifest osteoporosis. Reduction of pulmonary function is correlated significantly with clinical and radiological measures of severity of spinal deformation due to osteoporotic fractures.

Occupational Risks and Challenges of Seafaring: Marcus OLDENBURG, et al. Department of Maritime Medicine, Institute for Occupational and Maritime Medicine, Germany-Seafarers are exposed to a high diversity of occupational health hazards onboard ships. Objective: The aim of this article is to present a survey of the current, most i m p o r t a n t h a z a r d s i n s e a f a r i n g i n c l u d i n g recommendations on measures how to deal with these problems. Methods: The review is based on maritime expert opinions as well a PubMed analysis related to the occupational risks of seafaring. Results: Despite recent advances in injury prevention, accidents due to harmful working and living conditions at sea and of nonobservance of safety rules remain a main cause of injury and death. Mortality in seafaring from cardiovascular diseases (CVD) is mainly caused by increased risks and impaired treatment options of CVD at sea. Further, shipboard stress and high demand may lead to fatigue and isolation which have an impact on the health of onboard seafarers. Communicable diseases in seafaring remain an occupational problem. Exposures to hazardous substances and UV-light are important health risks onboard ships. Because of harsh working conditions onboard including environmental conditions, sufficient recreational activities are needed for the seafarers' compensation both onboard and ashore. However, in reality there is often a lack of leisure time possibilities. Discussion: Seafaring is still an occupation with specific work-related risks. Thus, a further reduction of occupational hazards aboard ships is needed and poses a challenge for maritime health specialists and stakeholders. Nowadays, maritime medicine encompasses a broad field of workplaces with different job-related challenges. (J Occup Health 2010; 52: 249-256) Review

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. Spinal X-rays were reviewed in all patients for the evidence of vertebral fractures. In osteoporotic patients, vertebral deformity was quantified by the spine deformity index (SDI) on X-rays. It was assessed whether subgroups could be identified by a combination of indices for spinal deformation (SDI, HR, DOW) using a cluster analysis. Back pain was a major complaint in both groups, without differences in pain intensity and frequency. Impairment of general well being and mood was found in about one-third of the patients in both groups. Independent of age, the disability score was significantly higher in patients with osteoporosis than in patients with CLBP. Both groups differed with respect to clinical measures of spinal deformity (HR, DOW, DIR). Among osteoporotic patients, parameters of quality of life were not linearly related to the degree of radiologically assessed vertebral deformity, but osteoporotic patients with two or more vertebral fractures tended to have more functional limitations than those with only one fracture. There was, however, a significant linear relationship between components of quality of life (disability score, pain) and clinical measures of spinal deformation (HR, DOW, DIR). The osteoporotic patients were subdivided into three clusters. The first group was characterized by low spinal deformation (2SDI, 2HR, 2DOW) and little impairment of quality of life. The second group had significantly greater spinal deformation (1SDI, 1HR, 1DOW) and significantly more pain and functional limitations. The third group was characterized by increased kyphosis, mainly caused by nonskeletal dysfunction (2SDI, 2HR, 1DOW), but pain and functional limitations were impaired to the same degree as in the second group with severe skeletal spinal deformation. We conclude that with respect to quality of life components, functional limitation is the most specific to spinal osteoporosis and is related to clinical measures of spinal deformation. Furthermore, spinal deformation and the clinical course of osteoporosis appears to be insufficiently reflected by radiological indices of vertebral deformity (such as SDI) alone. For grading the disease and for therapeutical concepts, radiological measures and clinical evaluation should be considered in combination. (J Bone Miner Res 1997;12:663-675)