title: Degenerative inter-vertebral disc disease osteochondrosis intervertebralis in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over.
abstract: To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time.
  
  
  
  In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature.
  
  
  
  Images from 10 132 participants (56% female, mean age 63.9 years) passed quality checks. Overall, 47% of men and women had DDD grade 3 or more in the lumbar spine and 36% in both thoracic and lumbar spine. Risk ratios for DDD grades 3 and 4, adjusted for age and anthropometric determinants, varied across a three-fold range between centres, yet prevalences were highly correlated in men and women. DDD was associated with flattened, non-ovoid inter-vertebral disc spaces. KL grade 4 and loss of inter-vertebral disc space were associated with higher spine aBMD.
  
  
  
  KL grades 3 and 4 are often used clinically to categorize radiological DDD. Highly variable European prevalences of radiologically defined DDD grades 3+ along with the large effects of age may have growing and geographically unequal health and economic impacts as the population ages. These data encourage further studies of potential genetic and environmental causes.
authors.affiliation: Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Armbrecht
authors.affiliation: Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Felsenberg
authors.affiliation: Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Ganswindt
authors.affiliation: NIHR Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, & Arthritis Research UK Centre for Epidemiology, Manchester, University of Manchester.
authors.forename: Mark
authors.initials: M
authors.lastname: Lunt
authors.affiliation: Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Kaptoge
authors.affiliation: Klinik fur Innere Medezin IV, Jena, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Abendroth
authors.affiliation: Rheumatology, Hospital de San Joao, Oporto, Portugal.
authors.forename: Antonio
authors.initials: A
authors.lastname: Aroso Dias
authors.affiliation: Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Bhalla
authors.affiliation: Nephrology, Asturias General Hospital, Oviedo, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cannata Andia
authors.affiliation: Rheumatology, University Hospital, Leuven, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Dequeker
authors.affiliation: Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.affiliation: Medicine, PKP Hospital, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Hoszowski
authors.affiliation: Laboratory for the Research of Musculoskeletal System, University of Athens, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Lyritis
authors.affiliation: Rheumatology, Institute of Rheumatic Diseases, Piestany, Slovakia.
authors.forename: Pavol
authors.initials: P
authors.lastname: Masaryk
authors.affiliation: Department of Epidemiology and Department of Internal Medicine, Erasmus University, Rotterdam, Netherlands.
authors.forename: Joyce
authors.initials: J
authors.lastname: van Meurs
authors.affiliation: Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Miazgowski
authors.affiliation: Institute of Clinical Medicine, University of Siena, Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.affiliation: 1st Department of Rheumatology and Metabolic Osteology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
authors.forename: Gyula
authors.initials: G
authors.lastname: Poór
authors.affiliation: Orthopaedics and Radiology, Malmö General Hospital, Malmö, Sweden.
authors.forename: Inga
authors.initials: I
authors.lastname: Redlund-Johnell
authors.affiliation: School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Reid
authors.affiliation: Rheumatology, Med Klinik & Polyklinik, Bochum, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Schatz
authors.affiliation: School of Health Sciences, The University of Manchester, Oxford Road, Manchester.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Todd
authors.affiliation: Institute of Health Care Research, Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, Royal Cornwall Hospital, Truro.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Woolf
authors.affiliation: Department of Epidemiology and Department of Internal Medicine, Erasmus University, Rotterdam, Netherlands.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rivadeneira
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculo-skeletal Biomedical Research Unit, Botnar Research Centre, Oxford, UK.
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Javaid
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculo-skeletal Biomedical Research Unit, Botnar Research Centre, Oxford, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculo-skeletal Biomedical Research Unit, Botnar Research Centre, Oxford, UK.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Silman
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculo-skeletal Biomedical Research Unit, Botnar Research Centre, Oxford, UK.
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculo-skeletal Biomedical Research Unit, Botnar Research Centre, Oxford, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Reeve
mesh_terms: D017677:Age Distribution; D000368:Aged; D015519:Bone Density; D015331:Cohort Studies; D005060:Europe; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D055034:Osteochondrosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography / Q000379:methods; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017678:Sex Distribution
keywords: Kellgren–Lawrence grading; age range 50 plus years; bone mineral density (BMD); degenerative disease; intervertebral disc; multi-centre prevalence study; osteochondrosis intervertebralis; plane radiology; population-based; reproducibility study