Prevalence and pattern of radiographic intervertebral disc degeneration in Vietnamese: a population-based study.

Intervertebral disc degeneration (IDD) is one of the most common skeletal disorders, yet few data are available in Asian populations. We sought to assess the prevalence and pattern of radiographic IDD in a Vietnamese population. This population-based cross-sectional investigation involved 170 men and 488 women aged ≥40 years, who were randomly sampled from the Ho Chi Minh City (Vietnam). Anthropometric data, clinical history and self-reported back and neck pain were ascertained by a questionnaire. Plain radiographs (from the cervical spine, thoracic spine to the lumbar spine) were examined for the presence of disc space narrowing and/or osteophytosis using the Kellgren-Lawrence (KL) grading system. The presence of radiographic IDD was defined if the KL grade was 2 or greater in at least one disc. The prevalence of radiographic IDD was 62.4% (n = 106) in men and 54.7% (n = 267) in women. The most frequently affected site was the lumbar spine with prevalence being 50.6 and 43.2% in men and women, respectively. The prevalence of IDD increased with advancing age: 18.8% among those aged 40-49 years, and increased to 83.4% in those aged ≥60 years. Self-reported neck pain and lower back pain were found in 30 and 44% of individuals, respectively. There was no statistically significant association between self-reported neck pain and cervical spine OA. These data suggest that radiographic IDD is highly prevalent in the Vietnamese population, and that self-reported back pain is not a sensitive indicator of IDD.

Prevalence of radiographic osteoarthritis of the knee and its relationship to self-reported pain.

BACKGROUND AND AIM: Osteoarthritis (OA) of the knee is one of the most common skeletal disorders, yet little data are available in Asian populations. We sought to assess the prevalence and pattern of radiographic OA of the knee, and its relationship to self-reported pain in a Vietnamese population. METHODS: The study was based on a sample of 170 men and 488 women aged ≥40 years who were randomly sampled from the Ho Chi Minh City (Vietnam). Radiographs of the knee were graded from 0 to 4 according to the Kellgren and Lawrence scale. Osteoarthritis was defined as being present in a knee if radiographic grades of 2 or higher were detected. Knee pain and symptoms were ascertained by direct interview using a structured questionnaire. RESULTS: The point prevalence of radiographic OA of the knee was 34.2%, with women having higher rate than men (35.3% vs 31.2%). The prevalence of knee OA increased with advancing age: 8% among those aged 40-49 years, 30% in those aged 50-59 years, and 61.1% in those aged ≥60 years. Greater BMI was associated with higher risk of knee OA. Self-reported knee pain was found in 35% of men and 62% of women. There was a statistically significant association between self-reported knee pain and knee OA (prevalence ratio 3.1; 95% CI 2.0 to 4.6). CONCLUSIONS: These data indicate that approximately a third of Vietnamese men and women have radiographic OA in the knee, and that self-reported knee pain may be used as an indicator of knee osteoarthritis.

Reference ranges for vertebral heights and prevalence of asymptomatic (undiagnosed) vertebral fracture in Vietnamese men and women.

UNLABELLED: Based on quantitative measurements of vertebral heights, the prevalence of undiagnosed vertebral fracture in Vietnamese men and women aged 50 years and older was 23 and 26 %, respectively. BACKGROUND: The present study sought to develop reference ranges for vertebral heights and to determine the prevalence of asymptomatic vertebral fracture in Vietnamese men and women. METHODS: The study included 312 men and 657 women aged over 18 who were randomly selected from the community. The ImageJ software program was used to measure anterior height (H(a)), middle height (H(m)), and posterior height (H(p)) for each vertebra (T4 to T12 and L1 to L5). Four vertebral ratios were determined: H(a)/H(p), H(m)/H(p), H(p)/H(p + 1), and H(p)/H(p − 1). Reference ranges for the ratios were then developed by the method of Winsorized mean. Vertebral fracture was diagnosed as a ratio lower than three standard deviations from the normal mean. RESULTS: For any given vertebra, H(a), H(m), and H(p) in men were higher than in women. In both sexes, H(a) and H(m) increased in a stepwise fashion from T4 to L3 and then gradually reduced in L4­L5. Vertebral heights for T4­T9 tended to decrease, while vertebral height for T10­L5 tended to increase with advancing age. Among those aged over 50 years, the prevalence of vertebral fracture in men was 23.3 % (95 % confidence interval (CI) 16.8­31.3 %) which was lower than that in women (26.5 %; 95 % CI 22.4­31.1 %). The prevalence increased with advancing age, such that from the age of over 70, 41 % of men and 42 % women had at least one vertebral fracture. CONCLUSION: One fourth of Vietnamese men and women aged 50 years and older have a symptomatic vertebral fracture. This prevalence is equivalent to that in Caucasian populations.

Reference ranges for bone mineral density and prevalence of osteoporosis in Vietnamese men and women.

BACKGROUND: The aim of this study was to examine the effect of different reference ranges in bone mineral density on the diagnosis of osteoporosis. METHODS: This cross-sectional study involved 357 men and 870 women aged between 18 and 89 years, who were randomly sampled from various districts within Ho Chi Minh City, Vietnam. BMD at the femoral neck, lumbar spine and whole body was measured by DXA (Hologic QDR4500). Polynomial regression models and bootstraps method were used to determine peak BMD and standard deviation (SD). Based on the two parameters, we computed T-scores (denoted by TVN) for each individual in the study. A similar diagnosis was also done based on T-scores provided by the densitometer (TDXA), which is based on the US White population (NHANES III). We then compared the concordance between TVN and TDXA in the classification of osteoporosis. Osteoporosis was defined according to the World Health Organization criteria. RESULTS: In post-menopausal women, the prevalence of osteoporosis based on femoral neck TVN was 29%, but when the diagnosis was based on TDXA, the prevalence was 44%. In men aged 50+ years, the TVN-based prevalence of osteoporosis was 10%, which was lower than TDXA-based prevalence (30%). Among 177 women who were diagnosed with osteoporosis by TDXA, 35% were actually osteopenia by TVN. The kappa-statistic was 0.54 for women and 0.41 for men. CONCLUSION: These data suggest that the T-scores provided by the Hologic QDR4500 over-diagnosed osteoporosis in Vietnamese men and women. This over-diagnosis could lead to over-treatment and influence the decision of recruitment of participants in clinical trials.

Prevalence and risk factors of radiographic vertebral fracture in postmenopausal Vietnamese women.

BACKGROUND: Vertebral fracture is associated with an increased risk of atraumatic fracture and mortality. The prevalence of vertebral fractures among postmenopausal Caucasian women has been reported to range between 15% and 35%. Because there is no estimate of the magnitude of the problem in Vietnam, we undertook this study to estimate the prevalence and risk factors of vertebral fracture in Vietnam. METHODS: Radiographs were taken from 209 postmenopausal women aged between 50 and 85 years (average 62) who were randomly sampled from various districts in Ho Chi Minh City. The presence of vertebral fracture was assessed by the Genant's semi-quantitative method with two independent readers. Bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN) and whole body was measured by DXA (Hologic QDR4500). Anthropometric and clinical data were obtained by a standardized questionnaire. RESULTS: Among the 209 women, 48 were found to have at least one radiographic vertebral fracture, which yielded a prevalence of 23% (95%CI: 18-29%). Although fracture occurred in all vertebrae, most (83%) occurred at the L1-L5. Most fractures occurred at one vertebra, and only 12% occurred at multiple vertebrae. The prevalence increased with age such that it reached 39% among those aged 70+ years. There was no significant association between vertebral fracture and back pain, fall history, and dietary calcium intake. In simple log-binomial regression analysis, higher risk of vertebral fracture was associated with advancing age (prevalence ratio [PR] per 10 years: 1.40; 1.16-2.05) and lower lumbar spine BMD (PR per SD: 1.51; 1.18-1.92). In multivariable analysis, the two factors remained independently associated with fracture risk, with the area under the receiver operating characteristic curve being 0.66. CONCLUSIONS: These data suggest that approximately one out of 4 postmenopausal women in Vietnam have a radiographic vertebral fracture, and this prevalence is as common as in Caucasian populations. The number of women needed to screen to identify one vertebral fracture is about 4 to 5, which seems to be cost-effective.