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Vertebral Scheuermann’s disease in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over

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Abstract

Summary

In 27 centres across Europe, the prevalence of deforming spinal Scheuermann’s disease in age-stratified population-based samples of over 10,000 men and women aged 50+ averaged 8 % in each sex, but was highly variable between centres. Low DXA BMD was un-associated with Scheuermann’s, helping the differential diagnosis from osteoporosis.

Introduction

This study aims to assess the prevalence of Scheuermann’s disease of the spine across Europe in men and women over 50 years of age, to quantitate its association with bone mineral density (BMD) and to assess its role as a confounder for the radiographic diagnosis of osteoporotic fracture.

Methods

In 27 centres participating in the population-based European Vertebral Osteoporosis Study (EVOS), standardised lateral radiographs of the lumbar and of the thoracic spine from T4 to L4 were assessed in all those of adequate quality. The presence of Scheuermann’s disease, a confounder for prevalent fracture in later life, was defined by the presence of at least one Schmorl’s node or irregular endplate together with kyphosis (sagittal Cobb angle >40° between T4 and T12) or a wedged-shaped vertebral body. Alternatively, the (rare) Edgren-Vaino sign was taken as diagnostic. The 6-point-per-vertebral-body (13 vertebrae) method was used to assess osteoporotic vertebral shape and fracture caseness. DXA BMD of the L2–L4 and femoral neck regions was measured in subsets. We also assessed the presence of Scheuermann’s by alternative published algorithms when these used the radiographic signs we assessed.

Results

Vertebral radiographic images from 4486 men and 5655 women passed all quality checks. Prevalence of Scheuermann’s varied considerably between centres, and based on random effect modelling, the overall European prevalence using our method was 8 % with no significant difference between sexes. The highest prevalences were seen in Germany, Sweden, the UK and France and low prevalences were seen in Hungary, Poland and Slovakia. Centre-level prevalences in men and women were highly correlated. Scheuermann’s was not associated with BMD of the spine or hip.

Conclusions

Since most of the variation in population impact of Scheuermann’s was unaccounted for by the radiological and anthropometric data, the search for new genetic and environmental determinants of this disease is encouraged.

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Acknowledgments

The acquisition of the images for this study was financially supported by a European Union Concerted Action Grant under BIOMED 1 (BMH1CT920182) and also EU grants C1PDCT925102, ERBC1PDCT 930105 and 940229. The central co-ordination for the data acquisition phase was also supported by the UK Arthritis Research Campaign, the Medical Research Council (G9321536) and the European Foundation for Osteoporosis and Bone Disease. The EU’s PECO program linked to BIOMED 1 funded in part the participation of the Budapest, Warsaw, Prague, Piestany, Szczecin and Moscow centres. The central x-ray evaluation for vertebral fracture was sponsored by the Bundesministerium fur Forschung and Technologie, Germany. The x-ray evaluation for other radiological aspects of this study was undertaken as part of a PhD studentship (to M.G.) and otherwise it was undertaken without external financial support. J.R., C.C. and K.J. acknowledge the support of the NIHR to the Biomedical Research Unit in Musculoskeletal Disease at the Botnar Research Centre, Oxford. Individual centres acknowledge the receipt of locally acquired support for their data collection. We thank the thousands of individuals who took part in the study and the many other individuals who helped access our population samples.

Conflicts of interest

None.

Author information

Author notes

  1. C. J. Todd

    Present address: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK

  2. A. J. Silman

    Present address: Arthritis Research UK, Chesterfield, S41 7TD, UK

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany

    G. Armbrecht, D. Felsenberg & M. Ganswindt

  2. ARC Epidemiology Unit, University of Manchester Musculoskeletal Biomedical Research Unit & Arthritis Research UK Centre for Epidemiology, Manchester, UK

    M. Lunt, A. J. Silman & T. W. O’Neill

  3. Department of Public Health and Primary Care, Strangeways Research Laboratory, Cambridge, UK

    S. K. Kaptoge & C. J. Todd

  4. Klinik fur Innere Medezin IV, Jena, Germany

    K. Abendroth

  5. Hospital de San Joao, Oporto, Portugal

    A. Aroso

  6. Röntgen u Nuklearmed, Krankenhaus Behring, Berlin, Germany

    D. Banzer

  7. Royal National Hospital for Rheumatic Diseases, Bath, UK

    A. K. Bhalla

  8. University Hospital, Leuven, Belgium

    J. Dequeker

  9. Department of Human Metabolism, University of Sheffield, Sheffield, UK

    R. Eastell

  10. PKP Hospital, Warsaw, Poland

    K. Hoszowski

  11. Laboratory for Research on the Musculoskeletal System, University of Athens, Athens, Greece

    G. Lyritis

  12. Centre de Médécine Specialisée Claude Gauthier, Montceau-les-Mines France & U Inserm 504, Lyon, France

    P. D. Delmas

  13. Institute of Rheumatic Diseases, Piestany, Slovakia

    P. Masaryk

  14. Department of Hypertension, Pomeranian Medical University, Szczecin, Poland

    T. Miazgowski

  15. Asturias General Hospital, Oviedo, Spain

    J. Cannata

  16. Institute of Clinical Medicine, University of Siena, Siena, Italy

    R. Nuti

  17. Departments of Epidemiology and Internal Medicine, Erasmus University, Rotterdam, Netherlands

    L. Oei & F. Rivadeneira

  18. National Institute of Rheumatology and Physiotherapy, Budapest, Hungary

    G. Poor

  19. Orthopaedics and Radiology, Malmö General Hospital, Malmö, Sweden

    I. Redlund-Johnell

  20. School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK

    D. M. Reid

  21. Charité Inst fur Rontgendiagnostik, Berlin, Germany

    W. Reisinger

  22. Med Klinik & Polyklinik Bochum, Bochum, Germany

    H. Schatz

  23. Royal Cornwall Hospital, Truro, UK

    A. D. Woolf

  24. NIHR Musculo-skeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre & Institute of Musculoskeletal Sciences, Windmill Road, Oxford, OX3 7LD, UK

    K. Javaid, C. Cooper & J. Reeve

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  1. G. Armbrecht
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Consortia

On behalf of the European Vertebral Osteoporosis Study (EVOS) and European Prospective Osteoporosis Study (EPOS) Groups

Corresponding author

Correspondence to J. Reeve.

Additional information

J. Reeve and A.J. Silman were EVOS and EPOS Project Co-ordinator.

P.D. Delmas is deceased.

Principal Investigators of the centres participating in both the EVOS and EPOS Study Groups: Aberdeen, UK—Reid DM; Athens, Greece—Lyritis G; Bath, UK—Bhalla AK; Berlin, Germany—Felsenberg D, Banzer D, Reisinger W; Bochum, Germany—Schatz H; Budapest, Hungary—Poor G; Cambridgeshire, UK—Todd CJ; Erfurt, Germany—Kragl G; Graz, Austria—Weber K; Harrow, UK—Reeve J; Heidelberg, Germany—Scheidt-Nave C; Jena, Germany—Abendroth K; Leuven, Belgium—Dequeker J; Lyon, France—Delmas PD; Lübeck, Germany—Raspe H; Malmö, Sweden—Johnell O; Manchester, UK—O’Neill TW; Moscow, Russia—Benevolenskaya L; Oporto, Portugal—Aroso A; Oviedo, Spain—Cannata J; Piestany, Slovakia—Masaryk P; Prague, Czech Republic—Havelka S; Rotterdam, Netherlands—Pols H; Siena, Italy—Nuti R; Szczecin, Poland—Miazgowski T; Truro, UK—Woolf AD; Warsaw, Poland—Hoszowski K; Yaroslavl, Russia—Yershova O; Zagreb, Croatia—Jajic I.

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Armbrecht, G., Felsenberg, D., Ganswindt, M. et al. Vertebral Scheuermann’s disease in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over. Osteoporos Int 26, 2509–2519 (2015). https://doi.org/10.1007/s00198-015-3170-6

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