title: Vertebral Scheuermann's disease in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over.
abstract: In 27 centres across Europe, the prevalence of deforming spinal Scheuermann's disease in age-stratified population-based samples of over 10,000 men and women aged 50+ averaged 8% in each sex, but was highly variable between centres. Low DXA BMD was un-associated with Scheuermann's, helping the differential diagnosis from osteoporosis.
  
  
  BACKGROUND
  This study aims to assess the prevalence of Scheuermann's disease of the spine across Europe in men and women over 50 years of age, to quantitate its association with bone mineral density (BMD) and to assess its role as a confounder for the radiographic diagnosis of osteoporotic fracture.
  
  
  METHODS
  In 27 centres participating in the population-based European Vertebral Osteoporosis Study (EVOS), standardised lateral radiographs of the lumbar and of the thoracic spine from T4 to L4 were assessed in all those of adequate quality. The presence of Scheuermann's disease, a confounder for prevalent fracture in later life, was defined by the presence of at least one Schmorl's node or irregular endplate together with kyphosis (sagittal Cobb angle >40° between T4 and T12) or a wedged-shaped vertebral body. Alternatively, the (rare) Edgren-Vaino sign was taken as diagnostic. The 6-point-per-vertebral-body (13 vertebrae) method was used to assess osteoporotic vertebral shape and fracture caseness. DXA BMD of the L2-L4 and femoral neck regions was measured in subsets. We also assessed the presence of Scheuermann's by alternative published algorithms when these used the radiographic signs we assessed.
  
  
  RESULTS
  Vertebral radiographic images from 4486 men and 5655 women passed all quality checks. Prevalence of Scheuermann's varied considerably between centres, and based on random effect modelling, the overall European prevalence using our method was 8% with no significant difference between sexes. The highest prevalences were seen in Germany, Sweden, the UK and France and low prevalences were seen in Hungary, Poland and Slovakia. Centre-level prevalences in men and women were highly correlated. Scheuermann's was not associated with BMD of the spine or hip.
  
  
  CONCLUSIONS
  Since most of the variation in population impact of Scheuermann's was unaccounted for by the radiological and anthropometric data, the search for new genetic and environmental determinants of this disease is encouraged.
authors.affiliation: Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Armbrecht
authors.affiliation: Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Felsenberg
authors.affiliation: Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ganswindt
authors.affiliation: ARC Epidemiology Unit, University of Manchester Musculoskeletal Biomedical Research Unit & Arthritis Research UK Centre for Epidemiology, Manchester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Kaptoge
authors.affiliation: Klinik fur Innere Medezin IV, Jena, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Abendroth
authors.affiliation: Hospital de San Joao, Oporto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Aroso
authors.affiliation: Röntgen u Nuklearmed, Krankenhaus Behring, Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Banzer
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Bath, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Bhalla
authors.affiliation: University Hospital, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Dequeker
authors.affiliation: Department of Human Metabolism, University of Sheffield, Sheffield, UK.
authors.forename: R
authors.initials: R
authors.lastname: Eastell
authors.affiliation: PKP Hospital, Warsaw, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Hoszowski
authors.affiliation: Laboratory for Research on the Musculoskeletal System, University of Athens, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Lyritis
authors.affiliation: Centre de Médécine Specialisée Claude Gauthier, Montceau-les-Mines France & U Inserm 504, Lyon, France.
authors.forename: P D
authors.initials: PD
authors.lastname: Delmas
authors.affiliation: Institute of Rheumatic Diseases, Piestany, Slovakia.
authors.forename: P
authors.initials: P
authors.lastname: Masaryk
authors.affiliation: Department of Hypertension, Pomeranian Medical University, Szczecin, Poland.
authors.forename: T
authors.initials: T
authors.lastname: Miazgowski
authors.affiliation: Asturias General Hospital, Oviedo, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Cannata
authors.affiliation: Institute of Clinical Medicine, University of Siena, Siena, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Nuti
authors.affiliation: Departments of Epidemiology and Internal Medicine, Erasmus University, Rotterdam, Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Oei
authors.affiliation: National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Poor
authors.affiliation: Orthopaedics and Radiology, Malmö General Hospital, Malmö, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Redlund-Johnell
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Reid
authors.affiliation: Charité Inst fur Rontgendiagnostik, Berlin, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Reisinger
authors.affiliation: Med Klinik & Polyklinik Bochum, Bochum, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schatz
authors.affiliation: Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK.|School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Todd
authors.affiliation: Royal Cornwall Hospital, Truro, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Woolf
authors.affiliation: NIHR Musculo-skeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre & Institute of Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK.
authors.forename: K
authors.initials: K
authors.lastname: Javaid
authors.affiliation: Departments of Epidemiology and Internal Medicine, Erasmus University, Rotterdam, Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Rivadeneira
authors.affiliation: ARC Epidemiology Unit, University of Manchester Musculoskeletal Biomedical Research Unit & Arthritis Research UK Centre for Epidemiology, Manchester, UK.|Arthritis Research UK, Chesterfield, S41 7TD, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Silman
authors.affiliation: NIHR Musculo-skeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre & Institute of Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: ARC Epidemiology Unit, University of Manchester Musculoskeletal Biomedical Research Unit & Arthritis Research UK Centre for Epidemiology, Manchester, UK.
authors.forename: T W
authors.initials: TW
authors.lastname: O'Neill
authors.affiliation: NIHR Musculo-skeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre & Institute of Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK. jonathan.reeve@ndorms.ox.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Reeve
mesh_terms: D000368:Aged; D001827:Body Height / Q000502:physiology; D015519:Bone Density / Q000502:physiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D015203:Reproducibility of Results; D012544:Scheuermann Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology
keywords: Bone mineral density; Fracture; Osteoporosis; Scheuermann’s disease