‘Healthier Chinese spine’: an update of osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong spine radiograph studies

Abstract

For the MrOS (Hong Kong) and MsOS (Hong Kong) baseline (BL) studies, community-dwelling 2,000 Chinese men (mean age: 72.3 years) and 2,000 Chinese women (mean age: 72.5 years) were recruited from 2001 to 2003. These two studies have spanned two decades till now. This review summarizes our spine radiograph results. Senile and post-menopausal osteoporosis were associated with intervertebral disc volume reduction; and in women, menopause accelerates disc degeneration. Elderly women's osteoporotic vertebral fracture (OVF) prevalence was double of that of elderly men. For year-4 follow-up (FU), male participants with BL OVF had little increased risk for further OVF. In our study comparing OVF rates in age-matched Hong Kong Chinese women and Italian Caucasian women (mean age: 74.1 years), endplate and/or cortex fracture (ECF) prevalence was 26% for Chinese and 47% for Italian. OVF with ≥40% vertebral height loss was recorded among 9.5% of the Chinese subjects while among 26% of the Italian subjects. OVFs in Italian subjects were more likely to be multiple and generally severer. Clinical spine fractures were recorded 133 cases/100,000 person-years in MrOS (Hong Kong) participants and 273 cases/100,000 person-years in MsOS (Hong Kong) participants. Literature review suggests the clinical vertebral fracture rates among elderly Hong Kong Chinese subjects are approximately half of those of American, Australian, and Canadian subjects. Data synthesis suggests elderly Caucasians have a higher degenerative spondylolisthesis prevalence, being approximately 70% higher than that of elderly Hong Kong Chinese. Literature review of other authors' publications shows, compared with Caucasians, Chinese have a much lower incident rate of back pain. We conclude that elderly Chinese have a generally healthier spine relative to elderly Caucasians.

An update of our understanding of radiographic diagnostics for prevalent osteoporotic vertebral fracture in elderly women

“…This has led to some practical difficulties. For example, osteoporotic hip fracture prevalence among Chinese is generally no more than half that of Caucasians (6,56), and we demonstrated that both radiographic OVF and clinical OVF follow the same trend with their prevalences among Chinese being no more than half of those among Caucasians (6,7,36). However, earlier studies reported that OVF among East Asians is as prevalent as that of Caucasians (57,58).…”

“…This itself suggests that ECF negative OVD is already an osteoporotic phenomenon distinct from those vertebrae without OVD. We consider positive ECF as an additional sign of OVF, and a positive ECF sign would increase the confidence for OVF diagnosis, but ECF is not an essential sign of OVF (36).…”

Estimations of bone mineral density defined osteoporosis prevalence and cutpoint T-score for defining osteoporosis among older Chinese population: a framework based on relative fragility fracture risks

“…Recent evidence suggests that, compared with Caucasians, the relative prevalence of osteoporotic vertebral fracture (OVF) follows the same pattern as other clinical fractures, with both radiographic and clinical OVF prevalences among older Chinese being no more than half of those of older Caucasians [Figures S1,S2 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)]. However, till now this conclusion heavily depends on the data from MrOS(Hong Kong) and MsOS(Hong Kong) studies.…”

Lumbar L3 marrow fat content in older Italian women is not apparently higher than in older Chinese women

“…It has recently been shown that older Hong Kong Chinese women have a much lower prevalence and severity of osteoporotic vertebral fracture (OVF) than age-matched Rome Caucasian women (1)(2)(3). In one study, we compared spine radiographs (T4-L5) from two epidemiological studies conducted in Hong Kong [MsOS(Hong Kong) n=200] and in Rome (Roman Osteoporosis Prevention Project, n=200, age-matched subjects with both mean age: 74.1 years and range: 65-87 years).…”

“…The Chinese subjects were from the MsOS(Hong Kong) study, which was an epidemiological research to study bone health among community dwelling Hong Kong Chinese women aged ≥65 years. The recruitment plan was designed so that the participants would represent the general elderly population in Hong Kong (3). At baseline all Hong Kong subjects were required to be able to walk without assistance, without bilateral hip replacement, and have the potential to survive the duration of primary study for at least 4 years as judged by their pre-existing medical status.…”