Background/Purpose: Scheuermann’s disease is one of the most frequent illnesses of the spine in teenagers. Its evolution over time is poorly understood. Spinal deformities, by impairing the biomechanics of spine, may be a new risk factor for osteoporotic vertebral fracture. Recently, prospective studies have demonstrated that disc space narrowing (DSN) and thoracic kyphosis could be new vertebral fracture risk factors and similar abnormalities are frequently observed in Scheuermann’s disease. Our objective was to examine whether Scheuermann’s disease is predictive of vertebral fracture in elderly men.

Methods:  We assessed the Scheuermann’s disease using the Berlin criteria (Armbrecht & al. Osteoporos Int, 2015, 26, 2509) among 766 spinal radiographs, made of men aged from 50 to 85 years old. Bone mineral density (BMD) was measured at baseline using a HOLOGIC 1500 QDR device. Data on incident vertebral fractures have been prospectively collected for 7,5 years and non-vertebral fractures for 10 years. We analyzed the relationship of Scheuermann’s disease and each of its diagnostic criteria with BMD and with the risk of fracture.

Results:  Scheuermann’s disease prevalence was 25,2%. Scheuermann’s disease was associated with lower BMD at the hip and higher BMD of lumbar spine and whole body after adjustment for age, weight, 17b-estradiol and 25-hydroxycholecalciferol. Vertebral fractures occurred in 27 men, peripheral fractures occurred in 60 men. Scheuermann’s disease was not associated with an increased risk of vertebral fracture. However, vertebral endplate irregularity, one of its diagnostic criteria, was associated with an increased vertebral fracture risk after adjustment for the age, weight, lumbar spine BMD, prevalent vertebral fractures, prior falls, overall score of DSN due to osteoarthritis (Odds ratio= 2.69, 95% CI: 1.16; 6.26, p<0.05). In individuals with Scheuermann’s disease, peripheral fracture risk was lower after adjustment for the age, weight, femoral neck BMD, prior fragility fracture (self-reported non-vertebral fractures and vertebral fractures), prior falls, overall score of DSN due to osteoarthritis, severe abdominal aortic calcification (Odds ratio= 0.47, 95% CI: 0.23; 0.99, p<0.05).

Conclusion:  In this prospective cohort study in elderly men, Scheuermann’s disease was not associated to an increased vertebral fracture risk, but with a decreased non vertebral fracture risk. Endplate irregularity, however, was substantially predictive of new vertebral fracture risk, which may be taken into account in the evaluation of the risk of fracture in elderly men.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-of-scheuermanns-disease-with-osteoporotic-vertebral-fracture-risk/