title: Older men with severe disc degeneration have more incident vertebral fractures-the prospective MINOS cohort study.
abstract: Data on the relationship between disc degeneration (DD) and fragility fractures in men are limited. The aim of this study was to prospectively analyse the risk of vertebral and non-vertebral fractures in men with thoracolumbar DD according to the severity of its radiological signs: disc space narrowing (DSN), osteophytes and endplate sclerosis.
  
  
  
  Men >50 years of age (n = 765) had lateral spine radiographs and DXA and were monitored prospectively. We analysed the risk of incident vertebral (7.5 years) and non-vertebral fractures (10 years) in men according to the severity of DD.
  
  
  
  After adjustment for age and weight, BMD increased with increasing total DSN score, endplate sclerosis and osteophytosis. Over 7.5 years, 28 incident vertebral fractures occurred in 27 men. After adjustment for age, BMI, spine BMD, prior fractures and abdominal aortic calcifications, the vertebral fracture risk was 3-fold higher in the upper DSN quartile vs men without DSN. After adjustment for the same confounders, vertebral fracture risk was also nearly 3-fold higher in the upper DSN quartile vs the three lower quartiles combined. Over 10 years, 61 men sustained non-vertebral fragility fractures. After adjustment for age, BMI, hip BMD, abdominal aortic calcifications and prior falls and fractures, the non-vertebral fracture risk decreased with increasing DSN score. The risk of non-vertebral fracture was half as high in men above the median total DSN score vs men below the median.
  
  
  
  In older men, severe DD is associated with higher BMD. Multilevel severe DSN is associated with higher vertebral fracture risk and lower non-vertebral fracture risk.
authors.affiliation: Department of Rheumatology, Hôpital Edouard Herriot, INSERM UMR 1033, University of Lyon, Lyon, France.
authors.forename: Charline
authors.initials: C
authors.lastname: Estublier
authors.affiliation: Department of Rheumatology, Hôpital Edouard Herriot, INSERM UMR 1033, University of Lyon, Lyon, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Chapurlat
authors.affiliation: Department of Rheumatology, Hôpital Edouard Herriot, INSERM UMR 1033, University of Lyon, Lyon, France pawel.szulc@inserm.fr.
authors.forename: Pawel
authors.initials: P
authors.lastname: Szulc
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D015519:Bone Density; D015331:Cohort Studies; D050723:Fractures, Bone / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D054850:Osteophyte / Q000000981:diagnostic imaging / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000453:epidemiology*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology
keywords: bone mineral density; disc degeneration; fracture; men; prospective cohort study