Vertebral deformity, bone mineral density, back pain and height loss in unscreened women over 50 years

Abstract

Bone mineral density (BMD) was measured in the lumbar spine using dual-energy X-ray absorptiometry in 222 unscreened women (aged 50-82 years), and information on back pain and historic loss of standing height was obtained at interview. Vertebral morphometry was performed on lateral spinal radiographs. The shape of the vertebral body was quantified using appropriate vertebral shape indices (VSIs), and vertebral deformities were identified using thresholds defined in terms of the means (M) and standard deviations (SD) of these VSIs for the whole group. Severity of deformity was defined as either grade 1 (M+2SD < VSI < M+3SD), grade 2 (M+3SD < VSI < M+4SD or grade 3 (VSI > M+4SD). Subjects with grade 1 vertebral deformities were older than subjects without such deformities, but did not have a reduced age-related Z-score of BMD. Grade 2 wedge and concave deformities were associated with a reduced age-related Z-score of BMD, suggesting that the aetiology of such deformities is closest to conventional concepts of 'osteoporotic fracture'. Grade 3 deformities were associated with neither increased age nor decreased BMD. Stature decreased in these subjects with age. Subjects reporting historic height loss had a higher mean number of wedge deformities. Subjects with back pain did not have a higher incidence of vertebral deformity than subjects without, confirming that many deformities were asymptomatic. Neither back pain nor historic loss of height were found to be associated with low spinal BMD.

Usefulness of Estimated Height Loss for Detection of Osteoporosis in Women

“…These results are consistent with previous authors postulating that the magnitude of height loss was greater in subjects with a vertebral deformity, one of the hallmarks of osteoporosis, and height is an indicator for vertebral fracture, one of the conditions of osteoporotic status (Ismail et al, 1999;Nicholson et al, 1993). These results indicated that the height loss could be one of the major factors for low bone density.…”

“…The data were thus collected similarly to studies that were conducted to confirm the relationships between bone mineral density, vertebral shape, and height, and to examine whether there was a decrease in the height recalled over the previous 20 years (Nicholson, Haddaway, Davie, & Evans, 1993;Moayyeri et al, 2006;Siminoski, Washawski, Jen, & Lee, 2006), and methods for recalling height at the age of 25 years, as used in a study using a questionnaire or a interview (Ismail et al, 1999;Tobias et al, 2007). The height loss was calculated by subtracting the current measurement of height from the recalled maximum height.…”

Positive relationship between bone mineral density and low back pain in middle-aged women

“…One previous study failed to identify any significant association between back pain and radial bone mineral content in middle-aged women [4]. A few former studies reported that back pain was not related to BMD in middle-aged and elderly women, although this conclusion was demonstrated by BMD measurement at the lumbar spine [14,24]. It was shown in a cross-sectional investigation that the prevalence of back pain with osteoporotic hip fracture was only half, or even less than half, that in a control group of the same age [38].…”

“…Many studies have been conducted on the various primary factors causing musculoskeletal disorders, and a positive association between vertebral deformity and LBP has been demonstrated in elderly people [6,9,14,15,20]. In spite of a large number of epidemiological surveys on the prevalence of LBP or BMD measurements in the general population, a relationship between the two has not been well documented, and the authors of several studies have even concluded that they were unable to find any evidence for such a relationship [4, 14,24]. The purpose of this study was to investigate whether the BMD value and other risk factors could be associated with the occurrence of LBP.…”

Low bone mineral status in adolescent idiopathic scoliosis

“…The histologic study by Enneking and Harrington [13] also found no significant correlation between asymmetrical growth of the posterior structures and the degree of histologic changes or the severity of the lateral curvature. However, it has been reported that low bone mineral density was strongly associated with the presence of vertebral wedge and loss of standing height in old patients [29]. A study on the associations between scoliosis and bone mineral density in a population of young women treated for scoliosis in adolescent was performed and the results indicated that the patients with osteopenia wore a brace for significantly longer duration and had more severe scoliosis in adulthood than those patients without osteopenia [12].…”