Degenerative inter-vertebral disc disease osteochondrosis intervertebralis in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over.

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.

Are there still east-to-west differences in the incidence of hip fractures in Germany?

UNLABELLED: There are large regional differences in the incidence of hip fracture in Germany. These differences were unexpected and do not follow a north-to-south or an east-to-west gradient. But they are of high socioeconomic importance and cannot be explained by geographic location, the age structure of the population, and only to a small extent by the regulation of specific medication. INTRODUCTION: The most important complications and the major cost factors of osteoporosis are fractures. In order to develop strategies for fracture prevention, knowledge about different incidence rates and possible causes is necessary. METHODS: In order to detect persistent differences in the incidence of hip fractures between the former eastern and western states of Germany, structured diagnostic data of patients hospitalized between 2000 and 2011 were used to determine the regional incidence of hip fractures in the individual federal states of Germany. To account for error due to repeated admissions and double registrations, the frequency of fractures was corrected by a factor of 0.89. RESULTS: Our analysis of the 10-year period from 2000 to 2011 did not confirm the difference between eastern and western Germany reported in the national literature, or the north-south gradient for Germany as reported in several European publications. We found significant differences in the incidence of fractures in adjacent territorial states such as Schleswig-Holstein and Mecklenburg-Western Pomerania or Saxony and Thuringia. Particularly, high incidence rates over the entire period were noted in the city-states of Hamburg, Berlin, and Bremen. CONCLUSION: The reason for such differences is still unclear and, thus, the consequences of urbanization must be considered to explain diverse incidence rates. In general, the investigation of causes should be based on the use of a multivariate model that takes additional factors such as specific drug use, socioeconomic aspects, environmental aspects, education, and health care into account. There are large regional differences in the incidence of hip fracture in Germany. These differences were unexpected and do not follow a north-to-south or an east-to-west gradient. But they are of high socioeconomic importance and cannot be explained by geographic location, the age structure of the population and only to a small extent by the regulation of specific medication.