@article{3108542,
    title = "Degenerative inter-vertebral disc disease osteochondrosis intervertebralis in Europe: Prevalence, geographic variation and radiological correlates in men and women aged 50 and over",
    author = "Armbrecht, G. and Felsenberg, D. and Ganswindt, M. and Lunt, M. and Kaptoge, S.K. and Abendroth, K. and Dias, A.A. and Bhalla, A.K. and Andia, J.C. and Dequeker, J. and Eastell, R. and Hoszowski, K. and Lyritis, G. and Masaryk, P. and van Meurs, J. and Miazgowski, T. and Nuti, R. and Póor, G. and Redlund-Johnell, I. and Reid, D.M. and Schatz, H. and Todd, C.J. and Woolf, A.D. and Rivadeneira, F. and Javaid, M.K. and Cooper, C. and Silman, A.J. and O'Neill, T.W. and Reeve, J. and Banzer, D. and Reisinger, W. and Kragl, G. and Weber, K. and Scheidt-Nave, C. and Delmas, P.D. and Raspe, H. and Johnell, O. and Benevolenskaya, L.I. and Aroso, A. and Cannata, J. and Masaryk, P. and Havelka, S. and Pols, H. and Yershova, O. and Jajic, I. and the joint European Vertebral Osteoporosis Study and European Prospective Osteoporosis Study Groups",
    journal = "Rheumatology (United Kingdom)",
    year = "2017",
    volume = "56",
    number = "7",
    pages = "1189-1199",
    publisher = "Oxford University Press",
    doi = "10.1093/rheumatology/kex040",
    keywords = "adult;  aged;  anthropometry;  Article;  assessment of humans;  bone density;  clinical assessment;  clinical evaluation;  controlled study;  degenerative disease;  disease severity;  Europe;  female;  human;  intervertebral disk disease;  Kellgren Lawrence scale;  lumbar spine;  male;  middle aged;  prevalence;  priority journal;  Scheuermann disease;  spine fracture;  spine radiography;  thoracic spine;  vertebra body;  age distribution;  clinical trial;  cohort analysis;  diagnostic imaging;  Intervertebral Disc Degeneration;  multicenter study;  osteochondrosis;  osteoporosis;  procedures;  prospective study;  radiography;  reproducibility;  severity of illness index;  sex ratio, Age Distribution;  Aged;  Bone Density;  Cohort Studies;  Europe;  Female;  Humans;  Intervertebral Disc Degeneration;  Male;  Middle Aged;  Osteochondrosis;  Osteoporosis;  Prevalence;  Prospective Studies;  Radiography;  Reproducibility of Results;  Severity of Illness Index;  Sex Distribution",
    abstract = "Objectives. 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. Methods. 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. Results. 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. Conclusion. 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. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved."
}