골다공증성 흉요추부 압박 골절에서 척추증과 골밀도의 관계
The Association between the Bone Mineral Density and Spinal Osteoarthritis in Osteoporotic Thoracolumbar Compression Fractures
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연구목적: 골다공증성 척추 압박 골절에서 척추증 및 척추 골밀도와의 연관성에 대해 알아보고자 하였다. 연구방법: 2008년 1월부터 2010년 6월까지 골다공증성 흉요추부 압박 골절 환자 56명의 환자 66예를 대상으로 하였다. 평균 연령은 76.2세였으며 남자가 8명, 여자가 48명이었다. 전 환자의 나이와 신체 질량지수 (body mass index, BMI; kg/m2)를 측정하였고, 말단골 정량적 전산화 단층촬영 (peripheral quantitative computed tomography, pQCT)을 이용하여 골밀도(bone marrow density, BMD) 검사를 시행하였다. 척추증은 흉요추 측면 단순 방사선 사진으로 척추체 전면 부위의 골극유무, 추간판 간격과 척추체 경화 변화 정도에 대해 각각 4단계로 평가, 합산하여 골밀도 및 골절 발생 추체와의 연관성에대해 통계 분석을 하였다. 결 과: 최초 급성 골절이 15예에서 발생하였고, 만성 골절이 동반된 51예의 전체 66예에서 급성 골절 부위는 요추 1번(30예, 45.4%)이 가장 많았다. 신체 질량지수의 평균은 23.32이며, 골밀도 T-점수는 -4.47였다. 체중 및 신장과 골밀도와의상관 관계는 통계학적으로 각각 유의하였다 (Pearson 상관 계수, P < 0.01). 척추체 피질골에서 척추증이 심할수록 골밀도가높았으며, 척추증이 없는 추체에서 압박 골절이 74.3%가 발생하였으며, 척추증이 존재하는 척추체에서는 압박 골절의 발생율이 22.4%로 나타났다 (P < 0.01). 골극이 존재하지 않은 추체에서 골절 발생 비율이 69%이었다 (P < 0.01). 결 론: 척추증이 있는 경우 추체 피질골의 골밀도는 척추증이 없는 경우에 비하여 높았으며, 압박 골절의 발생도 낮았다. 이는 척추증이 압박 골절의 발생과 만성 골절 후 인접 분절 골절 발생에 고려해야 할 하나의 인자로 사료된다.
Abstract
Objectives: The purpose of this study was to determine the association between the bone mineral density (BMD) and severity of spinal osteoarthritis (spondylosis) in osteoporotic spinal compression fracture. Methods: Fifty six patients were evaluated 66 cases had an osteoporotic thoracolumbar compression fracture between January 2008 and June 2010. The average patient age was 76.2 years (M/F : 8/48). Age and body mass index (BMI,kg/m2) were measured, and the BMD was performed using peripheral quantitative computed tomography (pQCT). Simple thoracolumbar (T-L) spine lateral radiography was evaluated for three criteria: presence of osteophytes, disc space narrowing and vertebral body sclerosis. The findings were graded 0 to 3 and analyzed statistically for a correlation with the BMD and fractured vertebrae. Results: Acute compression fractures comprised of 15 cases and the most common site of acute fractures with old fractures was lumbar spine (L1; 30 cases, 45.4%). The average of BMI was 23.32 and BMD (T-score) was -4.47. Pearson's rho showed a positive association between the weight, height and the BMD (P < 0.01). In terms of the BMD versus spondylosis, there was a positive association with high score in the high order cortical bone. Compression fractures occurrence rate in the absent and present of spondylosis was 74.3% and 22.4%, and 69% occur in the spinal segmental with no bony spur with chi-square test (P < 0.01). Conclusion: In the present of spondylosis was high score of cortical BMD and low rate of compression fracture. Spondylosis could be one of a factor of the occurrence in acute and adjacent compression fracture after old fractures. [Korean Journal of Bone Metabolism, 18(2): 119-124, 2011]
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