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Journal ArticleDOI

Relationship between hip bone mineral density and lumbar disc degeneration: a study in elderly subjects using an eight-level MRI-based disc degeneration grading system.

TL;DR: To study the relationship between hip bone mineral density, lumbar disc degeneration, and lumbary disc space narrowing in elderly subjects, a large number of subjects were randomly selected to undergo hip replacement surgery.
Abstract: 2Purpose: To study the relationship between hip bonemineral density (BMD), lumbar disc degeneration, andlumbar disc space narrowing in elderly subjects.Materials and Methods: The study cohort comprised 196females and 163 males (age range, 67–89 years) with noage difference between the two groups. Anteroposteriortotal hip areal BMD was measured with DXA and lumbarspine MRI was acquired using a 1.5 Tesla scanner. Lum-bar disc degeneration was assessed using an eight-levelgrading system wherein each grade represents a stepwiseprogression from normal disc to severe disc degenerationand disc space narrowing.Results: After controlling for the age effect, no significantrelationship was observed between total hip T-score sta-tus and severity of disc degeneration. There was no signif-icant difference in total hip BMD in the subjects with orwithout the disc space narrowing (P < 0.05). Female sub-jects are more likely to have a narrowed disc space thanmales at all levels, and being statistically significant atL3/4 and L4/5 levels, and with an overall significance ofP ¼ 0.007.Conclusion: There was no association observed betweenhip BMD and lumbar disc degeneration. Elderly femaleswere more likely to have a narrowed lumbar disc spacethan elderly males.Key Words: lumbar spine; osteopenia; osteoporosis; bonemineral density; intervertebral disc; degeneration; hipJ. Magn. Reson. Imaging 2011;33:916–920.
Citations
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Journal ArticleDOI
TL;DR: It was demonstrated that cage subsidence is relevant to BMD, and PLIF procedure which is conducted carefully can be a good surgical option to treat lumbar degenerative disease for osteoporotic patients.
Abstract: Study Design:A retrospective review of prospectively collected radiographic and clinical data.Objective:This study aims to investigate the relationship between cage subsidence and bone mineral density (BMD), and to reveal the clinical implications of cage subsidence.Summary of Background Data:Poster

97 citations


Cites background from "Relationship between hip bone miner..."

  • ...It is well known that degenerative change of disk is associated with increased endplate BMD.20,21 We assumed that increased BMD due to disk degeneration of PLIF site might be concerned with relatively low correlation coefficient....

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  • ...The average of BMD of cranial and caudal vertebrae at fusion level was assumed as fusion level BMD. Fusion segments were divided to normal BMD segments, osteoporotic segments ( 3.0 Tr 2.5), and severe osteoporotic segments (Tr 3.0)....

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  • ...Conclusions: This study revealed that cage subsidence is relevant to BMD....

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  • ...In this mentioned study, the methods of BMD measurement was not explained precisely and their postoperative disk space distraction compared with preoperative value was average 3.2mm, which was larger than other studies.24 It was reported that disk space overdistraction could result in cage subsidence.25 We could explain that this disagreement with our study resulted from the reason that BMD measurement was not conducted in PLIF site and disk space overdistraction impacted on cage subsidence more than BMD....

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  • ...It is well known that degenerative change of disk is associated with increased endplate BMD.(20,21) We assumed that increased BMD due to disk degeneration of PLIF site might be concerned with relatively low correlation coefficient....

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Journal ArticleDOI
TL;DR: Vertebral deformity had similar prevalence in older men and women, while vertebral fracture was more common in women, which is similar to previous reports of other East Asian women and Latin American women.
Abstract: This study investigated the prevalence of radiographic vertebral fractures using Genant’s semiquantitative (SQ) scoring system in elderly Chinese men (n = 2,000; mean age, 72.4 years) and women (n = 2,000; mean age, 72.6 years). Vertebral deformities had similar prevalence in elderly men (14.9 %) and women (16.5 %). Majority of the deformities in men were mild (9.9 %, grade = 1). The prevalence of vertebral fractures (grade ≥ 2) was 5.0 % among men and 12.1 % among women. Vertebral fracture is a serious consequence of osteoporosis and is often under-diagnosed. Researches on different ethnicities and territories to estimate the prevalence of vertebral fractures and to identify the risk factors are necessary. Mr. OS (Hong Kong) and Ms. OS (Hong Kong) represent the first large-scale cohort studies ever conducted on bone health in elderly Chinese men (n = 2,000) and women (n = 2,000). The current study investigated the prevalence of radiographic vertebral fractures in these subjects using Genant’s SQ scoring system and identified risk factors for vertebral fractures. The radiographs of all men (mean age, 72.4 years) and women (mean age, 72.6 years) were obtained. Six hundred twenty-seven subjects (15.7 %) had at least one vertebral deformity (SQ grade ≥ 1), including 297 men (14.9 %) and 330 women (16.5 %, p = 0.151). Three hundred forty-two participants (8.6 %) were defined as having at least one vertebra fracture (SQ grade ≥ 2), consisted of 100 men (5.0 %) and 242 women (12.1 %, p < 0.001). Older age, lower bone mineral density, lower physical activity, lower grip strength, fracture history, and low back pain were significantly associated with higher vertebral fracture rate for both men and women. Vertebral deformity had similar prevalence in older men and women, while vertebral fracture was more common in women. Majority of deformities in men was mild. The vertebral deformity prevalence of women from this study is similar to previous reports of other East Asian women and Latin American women.

89 citations

Journal ArticleDOI
TL;DR: MRI provides unique information about the lumbar disc nucleus pulposus and T1rho is better suited for evaluating AF in degenerated disc than T2, and both T1 rho and T2 relaxation times decrease similarly following disc degeneration.
Abstract: Objective To determine the relative performance of T1rho and T2 relaxation times in disc degeneration assessment.

75 citations

Journal ArticleDOI
TL;DR: The prevalence and severity ofDisc space narrowing are higher in elderly women than in elderly men, and a disc space narrowing score≥3 was associated with older age, higher spine and hip BMD, low back pain, and restricted leg mobility.
Abstract: Intervertebral disc degeneration is a common musculoskeletal condition. It can progress to disc herniation, spinal canal stenosis, and, in conjunction with facet joint arthrosis, degenerative spondylolisthesis. The factors initiating and influencing the progression of disc degeneration remain unclear. Nevertheless, there is a general agreement that spinal mechanical stress accelerates the progression of disc degeneration. Young men are more susceptible to disc degeneration than are young women, most likely due to increased mechanical stress and physical injury. Disc degeneration becomes apparent in men in the second decade of life, at almost a decade earlier than in women (1,2). The severity of age-matched disc degeneration is also generally greater in young and middle-aged men (1,2). In a recent MR imaging-based survey of young adults 20–22 years, lumbar disc degeneration was significantly more frequent in men (3). While young and middle-aged men are more likely to have lumbar disc degeneration than women, two recent population based studies indicated that this trend is reversed in elderly subjects, with women tending to have more severe lumbar disc degeneration than men. In a radiographic study of subjects 55 years and older, de Schepper et al (4) found that disc space narrowing (DSN) was more prevalent in women than men. Using an MR-based disc degeneration grading system, Wang et al. showed that elderly female subjects had more severe disc degeneration than elderly male subjects at all lumbar levels (5,6). It has been postulated that a decrease in estrogen level may be important with regard to accelerated disc degeneration in post-menopausal women (7). Mr Os (Hong Kong) and Ms OS (Hong Kong) represent the first large scale prospective cohort studies ever conducted on bone health in Asian men and women. Two thousand Chinese elderly men and two thousand Chinese elderly women were studied to determine the relationship between anthropometric, lifestyle, medical and other factors with bone mineral density (BMD) at the hip and spine. The purpose of this current study is four-fold: 1) to determine the prevalence of radiographic lumbar DSN in elderly Chinese men and women; 2) to confirm whether DSN is more prevalent in elderly Chinese women than men and how this changes among different age groups; 3) to investigate the relationship between DSN and BMD; and 4) to identify potential risk factors for lumbar DSN in Chinese population. Radiographic DSN is a manifestation of late stage disc degeneration.

67 citations


Cites background from "Relationship between hip bone miner..."

  • ...Men 1 476 (24) 614 (31) 718 (36) 764 (38) 2,572 (32) 2 94 (5) 156 (8) 187 (9) 520 (26) 957 (12) 3 19 (1) 52 (3) 71 (4) 166 (8) 308 (4) 1–3 589 (30) 822 (41) 976 (49) 1,450 (73) 3,837 (48) 2–3 113 (6) 208 (10) 258 (13) 686 (34) 1,265 (16) Women 1 447 (22) 612 (31) 673 (34) 655 (33) 2,387 (30) 2 118 (6) 252 (13) 281 (14) 589 (30) 1,240 (16) 3 50 (3) 88 (4) 96 (5) 192 (10) 426 (5) 1–3 615 (31) 952 (48) 1,050 (53) 1,436 (72) 4,053 (51) 2–3 168 (8) 340 (17) 377 (19) 781 (39) 1,666 (21)...

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  • ...In a previous smaller MRI-based cohort study (33), no significant relationship was observed between total hip T score status and severity of disc degeneration....

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Journal ArticleDOI
TL;DR: Gender-specific expression of ER might play a part in sexual dimorphism of IVD degeneration and gender and degeneration condition differences should be taken into account when the effects of estrogen on IVD metabolism are studied further.

36 citations

References
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Journal ArticleDOI
01 Sep 2001-Spine
TL;DR: Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation.
Abstract: Study design A reliability study was conducted Objectives To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system Summary of background data A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations The reliability of the assessment has a crucial influence on the validity of the data Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse Methods A grading system for lumbar disc degeneration was developed on the basis of the literature An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10-83 years) All scans were analyzed independently by three observers Intra- and interobserver reliabilities were assessed by calculating kappa statistics Results There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 084-090) and interobserver (kappa range, 069-081) Complete agreement was obtained, on the average, in 838% of all the discs A difference of one grade occurred in 159% and a difference of two or more grades in 13% of all the cases Conclusion Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation

3,048 citations


Additional excerpts

  • ...Pfirrmann et al (14) devised a clinically applicable grading system for disc degeneration based on MR 1Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People’s Republic of China....

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  • ...Pfirrmann et al (14) devised a clinically applicable grading system for disc degeneration based on MR (1)Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People’s Republic of China....

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Journal ArticleDOI
TL;DR: Because the validity and reliability of some of the existing data are uncertain, caution is needed in an assessment of the information on this type of pain.

2,983 citations


"Relationship between hip bone miner..." refers background in this paper

  • ...Over 90% of surgical spine procedures are performed on consequences of the disc degenerative process (4)....

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Journal ArticleDOI
15 Aug 2006-Spine
TL;DR: To suggest how intervertebral disc degeneration might be distinguished from the physiologic processes of growth, aging, healing, and adaptive remodeling, and to simplify the issue of causality.
Abstract: and Introduction Abstract Study Design: Review and reinterpretation of existing literature. Objective: To suggest how intervertebral disc degeneration might be distinguished from the physiologic processes of growth, aging, healing, and adaptive remodeling. Summary of Background Data: The research literature concerning disc degeneration is particularly diverse, and there are no accepted definitions to guide biomedical research, or medicolegal practice. Definitions: The process of disc degeneration is an aberrant, cell-mediated response to progressive structural failure. A degenerate disc is one with structural failure combined with accelerated or advanced signs of aging. Early degenerative changes should refer to accelerated age-related changes in a structurally intact disc. Degenerative disc disease should be applied to a degenerate disc that is also painful. Justification: Structural defects such as endplate fracture, radial fissures, and herniation are easily detected, unambiguous markers of impaired disc function. They are not inevitable with age and are more closely related to pain than any other feature of aging discs. Structural failure is irreversible because adult discs have limited healing potential. It also progresses by physical and biologic mechanisms, and, therefore, is a suitable marker for a degenerative process. Biologic progression occurs because structural failure uncouples the local mechanical environment of disc cells from the overall loading of the disc, so that disc cell responses can be inappropriate or aberrant. Animal models confirm that cell-mediated changes always follow structural failure caused by trauma. This definition of disc degeneration simplifies the issue of causality: excessive mechanical loading disrupts a disc's structure and precipitates a cascade of cell-mediated responses, leading to further disruption. Underlying causes of disc degeneration include genetic inheritance, age, inadequate metabolite transport, and loading history, all of which can weaken discs to such an extent that structural failure occurs during the activities of daily living. The other closely related definitions help to distinguish between degenerate and injured discs, and between discs that are and are not painful.

1,463 citations

Journal ArticleDOI
TL;DR: Find the susceptibility genes underlying osteoporosis requires identifying specific alleles that coinherit with key heritable phenotypes in bone strength, and identification of the genes underlying bone strength in mammals such as the mouse is likely to be of major assistance in human studies.
Abstract: Osteoporosis is a common multifactorial disorder of reduced bone mass. The disorder in its most common form is generalized, affecting the elderly, both sexes, and all racial groups. Multiple environmental factors are involved in the pathogenesis. Genes also play a major role as reflected by heritability of many components of bone strength. Quantitative phenotypes in bone strength in the normal population do not conform to a monogenetic mode of inheritance. The common form of osteoporosis is generally considered to be a polygenic disorder arising from the interaction of common polymorphic alleles at quantitative trait loci, with multiple environmental factors. Finding the susceptibility genes underlying osteoporosis requires identifying specific alleles that coinherit with key heritable phenotypes in bone strength. Because of the close correspondence among mammalian genomes, identification of the genes underlying bone strength in mammals such as the mouse is likely to be of major assistance in human studie...

430 citations

Journal ArticleDOI
15 Nov 2007-Spine
TL;DR: The modified Pfirrmann grading system is useful at discriminating severity of disc degeneration in elderly subjects and can be applied with good intra- and interobserver agreement.
Abstract: Study design A reliability study was conducted. OBJECTIVE.: To modify a grading system for lumbar disc degeneration and to test the reliability of this modified grading system. Summary of background data The 5-level Pfirrmann grading system for disc degeneration did not prove discriminatory when used to assess disc degeneration in the elderly spine. Such discriminatory power is necessary to test the association between other variables and severity of disc degeneration. Methods An 8-level modified grading system for lumbar disc degeneration was developed including a description of the changes expected for each grade and a 24-image reference panel. The reliability of the modified grading system was tested on 260 lumbar intervertebral discs in 52 subjects (26 men, 26 female) with a mean age of 73 years (range, 67-83 years). All examinations were analyzed independently by 3 readers. Intraobserver and interobserver reliabilities were assessed by calculating weighted kappa statistics. Results On average, for all 3 readers, 0.39% of the 260 discs were classified as Grade 2, 22% were classified as Grade 3, 21.5% were classified as Grade 4, 25.3% were classified as Grade 5, 19.1% were classified as Grade 6, 7.1% were classified as Grade 7, and 4.8% were classified as Grade 8. Intraobserver agreement was excellent (weighted kappa range, 0.79-0.91) with substantial interobserver agreement (weighted kappa range, 0.65-0.67). Complete intraobserver agreement was obtained, on average, in 85% of all discs with 84% of disagreement being as a result of a 1 grade difference. Complete interobserver agreement was obtained, on average, in 66% of all discs with 91% of disagreement being as a result of a 1 grade difference. Conclusion The modified Pfirrmann grading system is useful at discriminating severity of disc degeneration in elderly subjects. The system can be applied with good intra- and interobserver agreement.

367 citations