Spinal Deformity and the Musculoskeletal Cohort Study of the General Older Population

Article信州医学雑誌 69(3) : 111-120(2021)departmental bulletin pape

Osteoporosis Detection by Physical Function Tests in Resident Health Exams: A Japanese Cohort Survey Randomly Sampled from a Basic Resident Registry

Osteoporosis may increase fracture risk and reduce healthy quality of life in older adults. This study aimed to identify an assessment method using physical performance tests to screen for osteoporosis in community dwelling individuals. A total of 168 women aged 50–89 years without diagnosed osteoporosis were randomly selected from the resident registry of a cooperating town for the evaluation of physical characteristics, muscle strength, and several physical performance tests. The most effective combinations of evaluation items to detect osteoporosis (i.e., T-score ≤ −2.5 at the spine or hip) were selected by multivariate analysis and cutoff values were determined by likelihood ratio matrices. Thirty-six women (21.4%) were classified as having osteoporosis. By analyzing combinations of two-step test (TST) score and body mass index (BMI), osteoporosis could be reliably suspected in individuals with TST ≤ 1.30 and BMI ≤ 23.4, TST ≤ 1.32 and BMI ≤ 22.4, TST ≤ 1.34 and BMI ≤ 21.6, or TST < 1.24 and any BMI. Setting cut-off values for TST in combination with BMI represents an easy and possibly effective screening tool for osteoporosis detection in resident health exams

Cervical Spinal Alignment Change Accompanying Spondylosis Exposes Harmonization Failure with Total Spinal Balance: A Japanese Cohort Survey Randomly Sampled from a Basic Resident Registry

The relationship between spinal posture and quality of life has garnered considerable attention with the increase in older community-dwelling residents. However, details of this association remain insufficient. A recent Japanese population cohort epidemiological locomotion survey (the Obuse study) revealed that the C2–C7 cervical sagittal vertical axis (CSVA) began to increase in males from their 60s, but not in females. This study aimed to clarify the pathology of these cervical spondylotic changes. A total of 411 participants (202 male and 209 female) aged between 50 and 89 years were selected by random sampling from a cooperating town’s resident registry. All participants underwent lateral X-ray photography in a standing position for the measurement of several sagittal spinal alignment parameters, including CSVA, C2–C7 cervical lordosis (CL), T1 slope (T1S), and sagittal vertical axis (SVA). The presence of cervical spondylotic changes was also recorded. Associations of cervical sagittal spinal alignment with cervical spondylosis and between cervical and total sagittal spinal alignment were examined. The prevalence of cervical spondylosis was significantly higher in males (81%) than in females (70%) (p = 0.01). CL was significantly smaller in cervical spondylosis subjects when adjusted by age (3.4 degrees less; p = 0.01). T1S minus CL displayed a moderate positive correlation with CSVA in both males and females (r = 0.49 and 0.48, respectively, both p < 0.01). In males only, CSVA and CL showed weak positive correlations with SVA (r = 0.31 and 0.22, respectively, both p < 0.01) independently of age. Cervical spinal misalignment was more clearly associated with diminished SF-8TM scores in females than in males. In community-dwelling elderly residents, cervical sagittal spinal alignment change accompanying cervical spondylosis manifested as hypofunction to compensate for whole-spine imbalance

Male–female disparity in clinical features and significance of mild vertebral fractures in community-dwelling residents aged 50 and over

Abstract This investigation examined the clinical implications of mild vertebral fractures in older community-dwelling residents. Focusing on the locomotion health of older individuals, the earlier reported Obuse study enrolled 415 randomly sampled Japanese residents aged between 50 and 89 years, 411 of whom underwent X-ray evaluations for pre-existing vertebral fractures. A blinded assessment of vertebral fractures based on Genant’s criteria was conducted on the T5-L5 spine for rating on a severity scale. Grade 1 mild fractures were not linked to age in males, but increased with aging in females. Female participants had fewer Grade 1 and 2 fractures (P = 0.003 and 0.035, respectively) but more Grade 3 fractures (P = 0.013) than did males independently of age (Grade 1, 2, and 3: 25%, 16%, and 9% in females and 40%, 22%, and 6% in males, respectively). Weak negative correlations were observed between the number of fractures and bone mineral density in females for all fracture grades (Spearman’s rho: 0.23 to 0.36, P < 0.05). Our study showed that Grade 1 mild vertebral fractures in males lacked pathological significance, while in females they potentially indicated fragility fractures and were related to poor lumbopelvic alignment