Thoracic Kyphosis on Chest CT Scans Is Associated With Incident Vertebral Fractures in Smokers

Abstract

Greater kyphosis angles lead to increased loading on vertebral bodies in computational models. However, results about the relationship between severity of kyphosis and incident vertebral fracture (VF) risk have been conflicting. Therefore, the aim of this study was to evaluate associations between 1) prevalent VFs and severity of kyphosis, and 2) severity of kyphosis and incident VF risk in smokers with or without chronic obstructive pulmonary disease (COPD). Former and current smokers with or without COPD were included. CT scans were made at baseline, 1‐year, and 3‐year follow‐up. VFs were evaluated on superposed sagittal CT reconstructions. Kyphosis was measured as the angle between the lines above T4 and below T9 or T12. We included 1239 subjects (mean age 61.3 ± 8.0 years, 61.1% male, 80.6% with COPD), of whom 253 (20.4%) had a prevalent VF and 294 (23.7%) an incident VF within 3 years. Presence, number, and severity of prevalent VFs were associated with a greater kyphosis angle. The mean increase in kyphosis angle within 3 years was small but significantly greater in subjects with incident VFs compared with those without (2.2 ± 4.1 versus 1.2 ± 3.9 degrees, respectively, for T4 to T12 angle, p < 0.001). After adjustment for bone attenuation (BA) and prevalent VFs, baseline kyphosis angle was associated with incident VFs within 1 and 3 years (angle T4 to T12 per +1 SD, hazard ratio [HR] = 1.34 [1.12–1.61] and HR 1.29 [1.15–1.45], respectively). Our data showed that a greater kyphosis angle at baseline was independently associated with increased risk of incident VFs within 1 and 3 years, supporting the theory that greater kyphosis angle contributes to higher biomechanical loads in the spine. © 2019 American Society for Bone and Mineral Research.

Associations between bone attenuation and prevalent vertebral fractures on chest CT scans differ with vertebral fracture locations

“…walking, getting up from a chair, tying shoes when sitting) still occur at normal magnitudes, these subjects could be more susceptible to VF only in these less common regions. One example is that shear load on vertebrae is higher in T6–T10 than in T11–T12 [ 27 ].…”

“…More details about subjects, image processing, VF assessment and BA measurement have been published elsewhere [ 27 ].…”

Severe Kyphosis Patients with Tuberculosis and Chronic Obstructive Pulmonary Disease: A Case Report

“…Thoracic Severe kyphosis therapy attempts to restore physical function, reduce pain, and reduce excessive anteroposterior curvature [13]. The resultant damage from COPD, combined with the aging process, will have a deleterious impact on the entire body in elderly adults with thoracic kyphosis [14,15]. We present severe kyphosis patients with tuberculosis and COPD in this study.…”

Relationship between chronic obstructive pulmonary disease and adiponectin concentrations: An updated meta-analysis and single-cell RNA sequencing

“…Chronic obstructive pulmonary disease (COPD) is a common yet treatable and preventable condition marked by persistent airflow obstruction as well as respiratory symptoms caused by alveolar and/or airway heterogeneity due to exposure to large amounts of harmful gases or other particles. [ 1 , 2 ] Globally, COPD has emerged as a worldwide public health challenge because of its high prevalence, disability rates, and mortality rates. Additionally, the social and economic burden of COPD will become increasingly serious [ 3 ] with the prominence of aging populations, high smoking rates, and air pollution.…”