Influence of Physical Activity on Vertebral Deformity in Men and Women: Results from the European Vertebral Osteoporosis Study

Physical activity is associated with an increased bone mass and a reduced risk of hip fracture. There are, however, no data from population samples of men and women concerning the effect of regular levels of physical activity on the risk of vertebral deformity. The aim of this study was to determine the relationship between regular physical activity and vertebral deformity in European men and women. A population survey method was used. Thirty-six centers from 19 European countries participated. Each center recruited a population sample of men and women aged 50 years and over. Those who took part received an interviewer-administered questionnaire and lateral thoracolumbar radiographs. Subjects were asked about two dimensions of physical activity: (1) the level of physical activity undertaken either at work or at home on a daily basis at three different age periods: 15–25 years, 25–50 years, and 50+ years; and (2) the amount of time spent walking or cycling out of doors each day. Spinal radiographs were evaluated morphometrically and the presence of vertebral deformity was defined according to the McCloskey method. In total, 14,261 subjects, aged 50–79 years, from 30 centers were studied, of whom 809 (12.0%) men and 884 (11.7%) women had one or more deformities. After adjusting for age, center, smoking, and body mass index, very heavy levels of activity in all three age groups were associated with an increased risk of vertebral deformity in men (odds ratios, age adjusted [OR], 1.5–1.7; with all 95% confidence intervals [CI] excluding unity). No increased risk was observed in women. Current walking or cycling more than ½ h/day was associated with a reduced risk of vertebral deformity in women (OR 0.8; 95% CI 0.7–1.0). We conclude that regular walking in middle-aged and elderly women is associated with a reduced risk of vertebral deformity. By contrast, heavy levels of physical activity in early and middle adult life are associated with an increased risk in men. These differences are of relevance in understanding the epidemiology of vertebral deformity and planning programs of prevention

Bone Density Variation and Its Effects on Risk of Vertebral Deformity in Men and Women Studied in Thirteen European Centers: The EVOS Study

In Europe there is a 3‐fold variation, according to geographical center, in risk of vertebral deformity in men and women over the age of 50. We investigated the relationship between bone density, as assessed by dual‐energy X‐ray absorptiometry (DEXA) of the spine and hip and prevalent vertebral deformities in 13 of the 36 centers participating in the European Vertebral Osteoporosis Study (EVOS). Each center recruited an age‐stratified sample of men and women aged 50 years and over, and of those who agreed to densitometry, 288/2088 women and 233/1908 men were found to have one or more deformities of the vertebrae between T4 and L4 as assessed by the McCloskey algorithm. DEXA was in each case performed on L2–L4, the proximal femur, or both. Bone densitometry results were cross‐calibrated between centers using the European Spine Phantom prototype and results expressed as bone mineral density (BMD, g/cm2). In both genders, subjects with deformities involving loss of anterior vertebral body height alone comprised over 20% of the total with deformities and these related poorly to BMD. Other classes of deformity were found by logistic regression to relate significantly to BMD in one or both genders, with odds ratios for the risk of any of these ranging from 1.67 to 2.11 for a 1 SD reduction in bone density at spine, femoral neck, or trochanter (p < 0.001). Adjusting for anthropometric variables and BMD did not remove the effect of age on risk which rose 1.67‐ to 1.78‐fold per decade according to gender. The greater unadjusted rate of increase in deformity risk with age in women was attributable to their faster rate of bone loss with age; after adjusting for age, body mass index (BMI), and BMD at the trochanter in grams per square centimeter, men had a 2‐fold higher risk of deformity than women. Analysis of the relationship between mean bone density and the prevalence of deformity in each center demonstrated no significant differences between centers in either gender, after adjusting for BMD, age, and BMI together with an a posteriori statistical adjustment for imperfect cross‐calibration of densitometers. It is concluded that BMD is an important determinant of deformity risk in both genders. Together with age, BMD explains much of the differences in risk both between the sexes and between individual geographical centers in Europe