Bone health and back pain: What do we know and where should we go?

Abstract

Bone health is generally not considered in patients who present with chronic back pain. Nonetheless, bone health and back pain share common genetic and environmental correlates suggesting a co-dependence. Evidence exists for a relationship between back pain and impaired bone health. Here we present the evidence, theoretic framework and clinical relevance. Bone health and back pain are important determinants of musculoskeletal health. Back pain experienced in youth is a risk factor for future back pain, while suboptimal bone health during development increases the risk of skeletal fragility in later life. Generally, bone health is not considered in patients with chronic back pain who do not demonstrate other well-recognised bone health risk factors or associated conditions. Nonetheless, evidence suggests that back pain and impaired bone health share common environmental and genetic correlates, indicating that bone health ought to be considered in the context of back pain in otherwise healthy individuals. This review describes the likely mechanisms explaining the relationship between back pain and impaired bone health, evidence concerning the relationship and suggestions for future research. A narrative literature search was conducted using CINAHL, Medline, PubMed and Web of Science electronic databases. A history of back pain is associated with decreased bone mineral density in adults, yet this tends to be site-specific. No studies were identified examining this association in youth, yet the negative effects of childhood skeletal trauma and obesity on bone and spinal health provide indirect evidence for an association. Further research is required to clarify the impact of back pain on bone health at different lifespan stages using prospective cohort designs.

Vertebral Bone Mineral Measures and Psychological Wellbeing among Individuals with Modic Changes

“…4,5 The sequelae via both pathways may have important implications for bone health,6 specifically bone mineral density (BMD), although this issue has not been studied in detail. While intervertebral disc degeneration has been associated previously with changes in the distribution of intra-vertebral bone mass7 and therefore is likely to have implications for vertebral bone strength, this has not been linked explicitly with MCs.…”

“…In particular, depression has been linked to reduced BMD through cortisol dynamics 9. Pain catastrophizing attitudes, common among individuals who experience chronic musculoskeletal pain, have been linked to passive coping behaviours and depression, and increase the risk of poor outcomes from CLBP,10 which may have implications for bone health 6. In the context of MCs, the association between CLBP and BMD may be more pronounced and therefore have implications for surgical interventions commonly undertaken for these disorders, such as discectomy, arthrodesis, and total disc replacement 11–13.…”

“…In the context of MCs, the association between CLBP and BMD may be more pronounced and therefore have implications for surgical interventions commonly undertaken for these disorders, such as discectomy, arthrodesis, and total disc replacement 11–13. For example, the combination of inflammation associated with type 1 lesions and the clinically-observed high levels of pain, disability and poor psychological wellbeing in patients with CLBP and MCs may strengthen the relationship between CLBP and BMD 6. While some clinical characteristics of individuals with CLBP and MCs have been reported previously,3,8 these have not specifically addressed BMD and psychological wellbeing, nor the combination of these factors with inflammation.…”

Lumbar Bone Mass Predicts Low Back Pain in Males

“…31 Therefore, this study presents evidence for an association between lumbar bone mass and LBP among a population that is not characterized by osteoporosis or old age, which may confound this relationship. 21 With BMC and BMD defi ned as categorical variables, results showed that, only for men, those with lower values of BMC and BMD had a 3 to almost 5 times higher risk of reporting LBP 6 years later than men belonging…”

“…Bisschop et al, unpublished data). 18 In a recent review of the literature, limited evidence for a relationship between BMD and back pain was found, 21 and studies with a prospective design were recommended. The objective of this study was, therefore, to investigate the longitudinal relationship of BMC and BMD with LBP in a representative sample of the general population, and it was hypothesized that low BMC and BMD values are associated with an increased risk for LBP.…”