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

G. Armbrecht, D. Felsenberg, M. Ganswindt, M. Lunt, S. K. Kaptoge, K. Abendroth, A. Aroso, D. Banzer, A. K. Bhalla, J. Dequeker, R. Eastell, K. Hoszowski, G. Lyritis, P. D. Delmas, P. Masaryk, T. Miazgowski, J. Cannata, R. Nuti, L. Oei, G. PoorI. Redlund-Johnell, D. M. Reid, W. Reisinger, H. Schatz, C. J. Todd, A. D. Woolf, K. Javaid, F. Rivadeneira, A. J. Silman, C. Cooper, T. W. O'Neill, J. Reeve*, EVOS, Epos Group

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


The 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 > 40A degrees 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.

Original languageEnglish
Pages (from-to)2509-2519
Number of pages11
JournalOsteoporosis International
Issue number10
Early online date29 May 2015
Publication statusPublished - Oct 2015

Bibliographical note

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.


  • bone mineral density
  • fracture
  • Scheuermann's disease
  • osteoporosis
  • follow-up
  • prospective osteoperosis
  • thoracic kyphosis
  • osteo-arthrosis
  • bone-density
  • farcture
  • deformity
  • pathogenesis
  • population
  • history


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