Journal Article•
Relationship between radiographic features and bone mineral density in elderly men.
TL;DR: The radiographic features of lumbar disc degeneration, anterior osteophytes, and end plate sclerosis were associated with an increase in BMD at the spine, and there was a strong negative correlation in terms of age at the femoral neck, though not at the backbone.
Abstract: Lumbar disc degeneration is characterised radiologically by the presence of osteophytes, endplate sclerosis, and disc space narrowing. Our study was designed to assess anterior lumbar osteophytes, disc space narrowing, end plate sclerosis, and bone mineral density (BMD) in the lumbar vertebrae and femoral neck of elderly men. A total of 1000 men, aged between 71 and 90 years, were invited to participate in the study. BMD was assessed at the spine and femoral neck using dual energy X-ray absorptiometry (DXA). We examined the relationship with the degree of lumbar spinal and femoral neck deformity by using the Z-score. Lateral and anterioposterior spinal radiographs were evaluated for features of lumbar disc degeneration. The observers consisted of a consultant physical therapist, a radiologist, and anatomists who together studied the series of radiographs. Anterior lumbar osteophytes (grade 0-3), end-plate sclerosis, and disc space narrowing (grade 0-2) were evaluated. The Pearson correlation test was used to determine the association between radiographic features, the lumbar mineral density (LBMD), and femoral neck mineral density (FNBMD). In all, 90.6% of lumbar vertebral levels showed evidence of anterior osteophytes, 87.5% showed evidence of end plate sclerosis, and 68.2% of disc space narrowing. Additionally, there was a strong negative correlation in terms of age at the femoral neck, though not at the spine. On the other hand, there was a significant correlation between osteophyte grade and end plate sclerosis at the spine. In our study, the radiographic features of lumbar disc degeneration, anterior osteophytes, and end plate sclerosis were associated with an increase in BMD at the spine.
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TL;DR: A retrospective analysis of the body composition, BMI, and BMD of 358 Chinese male outpatients between 50 and 89 years of age that were recruited from the authors' hospital between 2009 and 2011 indicated that LMI and FFMI exhibited significant negative associations with aging.
Abstract: Objectives
Aging, body composition, and body mass index (BMI) are important factors in bone mineral density (BMD). Although several studies have investigated the various parameters and factors that differentially influence BMD, the results have been inconsistent. Thus, the primary goal of the present study was to further characterize the relationships of aging, body composition parameters, and BMI with BMD in Chinese Han males older than 50 years.
Methods
The present study was a retrospective analysis of the body composition, BMI, and BMD of 358 Chinese male outpatients between 50 and 89 years of age that were recruited from our hospital between 2009 and 2011. Qualified subjects were stratified according to age and BMI as follows: 50–59 (n = 35), 60–69 (n = 123), 70–79 (n = 93), and 80–89 (n = 107) years of age and low weight (BMI: < 20 kg/m2; n = 21), medium weight (20 ≤ BMI < 24 kg/m2; n = 118), overweight (24 ≤ BMI < 28 kg/m2; n = 178), and obese (BMI ≥ 28 kg/m2; n = 41). Dual-energy X-ray absorptiometry (DEXA) was used to assess bone mineral content (BMC), lean mass (LM), fat mass (FM), fat-free mass (FFM), lumbar spine (L1-L4) BMD, femoral neck BMD, and total hip BMD. Additionally, the FM index (FMI; FM/height2), LM index (LMI; LM/height2), FFM index (FFMI; [BMC+LM]/height2), percentage of BMC (%BMC; BMC/[BMC+FM+LM] × 100%), percentage of FM (%FM; FM/[BMC+FM+LM] × 100%), and percentage of LM (%LM; LM/(BMC+FM+LM) × 100%) were calculated. Osteopenia or osteoporosis was identified using the criteria and T-score of the World Health Organization.
Results
Although there were no significant differences in BMI among the age groups, there was a significant decline in height and weight according to age (p < 0.0001 and p = 0.0002, respectively). The LMI and FFMI also declined with age (both p < 0.0001) whereas the FMI exhibited a significant increase that peaked in the 80-89-years group (p = 0.0145). Although the absolute values of BMC and LM declined with age (p = 0.0031 and p < 0.0001, respectively), there was no significant difference in FM. In terms of body composition, there were no significant differences in %BMC but there was an increase in %FM (p < 0.0001) and a decrease in %LM (p < 0.0001) with age. The femoral neck and total hip BMD significantly declined with age (p < 0.0001 and p = 0.0027, respectively) but there were no differences in L1-L4. BMD increased at all sites (all p < 0.01) as BMI increased but there were declines in the detection rates of osteoporosis and osteopenia (both p < 0.001). A logistic regression revealed that when the medium weight group was given a BMI value of 1, a decline in BMI was an independent risk factor of osteoporosis or osteopenia, while an increase in BMI was a protective factor for BMD. At the same time, BMD in L1-L4 exhibited a significant positive association with FMI (p = 0.0003) and the femoral neck and total hip BMDs had significant positive associations with FFMI and LMI, respectively (both p < 0.0001).
Conclusions
These data indicate that LMI and FFMI exhibited significant negative associations with aging in Chinese Han males older than 50 years, whereas FMI had a positive association. BMD in the femoral neck and total hip declined with age but an increased BMI was protective for BMD. LMI and FFMI were protective for BMD in the femoral neck and total hip.
57 citations
Cites background from "Relationship between radiographic f..."
...A previous study of 1000 males between 71 and 90 years old indicated that the radiographic features of lumbar disc degeneration, anterior osteophytes, and end-plate sclerosis were associated with BMD increasing in the lumbar spine [67]....
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TL;DR: Study results suggest that somatic dysfunction was more significant in chronic LBP participants and segmental BMD T scores were higher for vertebrae demonstrating moderate/severe rotational asymmetry and tenderness.
Abstract: Context: Somatic dysfunction as diagnosed by palpation should be associated with an objective measure. Bone mineral density (BMD) has been shown to be elevated in lumbar vertebrae with somatic dysfunction and in the lumbar region of individuals with chronic low back pain (LBP). Objective: To investigate the association of lumbar somatic dysfunction and BMD T-score variability in participants with chronic LBP and without LBP (non-LBP) and to determine the reproducibility of previously published results. Methods: Two examiners, blinded to symptom history, evaluated participants for tissue texture abnormalities, rotational asymmetry, anterior motion restriction, and tenderness at vertebral levels L1 to L4. Participants also underwent dual-energy xray absorptiometry of vertebral levels L1 to L4 for the assessment of BMD T scores. Generalized linear models were used to compare the chronic LBP and non-LBP groups on the presence and severity of somatic dysfunction and to test whether group and the presence and severity of somatic dysfunction were related to BMD T scores. Results: Forty-three chronic LBP (54%) and 36 non-LBP participants (46%) completed the study. Although the presence of somatic dysfunction in the 2 groups was not significantly different, the presence of tenderness was significantly more common in the chronic LBP group (P<.001), as was the severity for tissue texture abnormalities (P=.03), motion restriction (P=.04), and tenderness (P<.001). Of the 316 vertebrae assessed, 31 (10%, all in the chronic LBP group) had moderate/ severe tenderness. The vertebral somatic dysfunction burden score, the total somatic dysfunction burden score, the vertebral somatic dysfunction severity score, and the total somatic dysfunction severity score were higher in the chronic LBP group (all P<.001). The vertebral BMD T score was significantly higher for vertebrae demon strating moderate/severe rotational asymmetry compared with those demonstrating mild or no rotational asymmetry (P=.01) and for vertebrae demonstrating moderate/ severe tenderness compared with those demonstrating no tenderness (P=.04). Conclusion: Study results suggest that somatic dysfunction was more significant in chronic LBP participants. Although the correlation between the presence of somatic dysfunction and segmental BMD T scores was not reproduced, BMD T scores were higher for vertebrae demonstrating moderate/severe rotational asymmetry and tenderness.
6 citations
TL;DR: It is demonstrated the possibility that MT intervention delay the lumbar IVD degeneration in aging rats, specifically improving the motor function and regulating senescence-associated β-galactosidase, p53, p21, p16, and telomerase activity to retard thesenescence of cells in IVDs.
Abstract: With the increasing burden of a globally aging population, low back pain has become one of the most common musculoskeletal disorders, caused mainly by intervertebral disc (IVD) degeneration. There are currently several clinical methods to alleviate back pain, but there is scarce attention paid as to whether they can improve age-related IVD degeneration. It is therefore difficult to conduct an in-depth evaluation of these methods. A large number of clinical studies have shown that manual therapy (MT), a widely used comprehensive alternative method, has effects on pain, the mechanisms of which require further study. In this study, MT was performed on aging rats for 6 months, and their behaviors were compared with those of a non-intervention group of aging and young rats. After the intervention, all rats were examined by X-ray to observe lumbar spine degeneration, and the IVD tissues were dissected for detection, including pathological staining, immunofluorescence, Western bolt, etc. This study demonstrated the possibility that MT intervention delay the lumbar IVD degeneration in aging rats, specifically improving the motor function and regulating senescence-associated β-galactosidase, p53, p21, p16, and telomerase activity to retard the senescence of cells in IVDs. Moreover, MT intervention can modify oxidative stress, increase the expression of SIRT1 and FOXO1 in IVDs and decrease ac-FOXO1 expression, suggesting that MT can reduce oxidative stress through the SIRT1/FOXO1 pathway, thereby playing a role in delaying the aging of IVDs. This study shows that drug-free, non-invasive mechanical interventions could be of major significance in improving the physical function of the elderly.
5 citations
TL;DR: Separate analyses of BMC and area change revealed that the significance of aBMD changes in aging was very divergent among sites and between sexes, suggesting that the authors should be more cautious when interpreting the meaning of a BMD change.
Abstract: Bone mineral density (aBMD) is equivalent to bone mineral content (BMC) divided by area We rechecked the significance of aBMD changes in aging by examining BMC and area separately Subjects were 1167 community-dwelling Japanese men and women, aged 40–79 years ABMDs of femoral neck and lumbar spine were assessed by DXA twice, at 6-year intervals The change rates of BMC and area, as well as aBMD, were calculated and described separately by the age stratum and by sex In the femoral neck region, aBMDs were significantly decreased in all age strata by an increase in area as well as BMC loss in the same pattern in both sexes In the lumbar spine region, aBMDs decreased until the age of 60 in women, caused by the significant BMC decrease accompanying the small area change Very differently in men, aBMDs increased after their 50s due to BMC increase, accompanied by an area increase Separate analyses of BMC and area change revealed that the significance of aBMD changes in aging was very divergent among sites and between sexes This may explain in part the dissociation of aBMD change and bone strength, suggesting that we should be more cautious when interpreting the meaning of aBMD change
4 citations
Cites background from "Relationship between radiographic f..."
...The increase in BMC together with the area may be explained by the osteophyte formation found to be more marked in elderly men [7, 9]....
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Journal Article•
TL;DR: The bone geometry parameters from either DXA scans orplain radiographs may be used to predict osteoporotic hip fracture with a moderate to high correlation.
Abstract: Background : Fracture prevention in osteoporotic patients is the primary treatment goal in assessing bone mineral density, identification of fracture risk, and determination of who should be treated. The literature shows that parameters of proximal femoral bone geometry such as hip axis length, femoral neck shaft angle (FNA), femoral neck width (FNW) and femoral neck cortical thickness (FNCT) can predict the risk of hip fracture. Those parameters are presented automatically with dual energy X-ray absorptiometry (DXA) scans, which are available in well-equipped hospitals. Objective : To determine the correlation between proximal femoral bone geometry and the parameters from DXA scans and those from plain radiographs. Material and Method : Forty-eight patients with no previous hip fractures or history of secondary osteoporosis underwent both a DXA scan of the hip area and a plain hip radiograph done in the same position, 25 degrees internal rotation. Bone geometries from both groups were measured to determine the correlation using Pearson correlation coefficient. Results : Correlation between the parameters HAL, FNA, FNW and FNCT from the DXA scans and from the measurement of the plain radiograph was significant (p<0.01) and the level of correlation was moderate to high. The FNCT had least mean difference (0.04). In addition, the parameter FNCT, less than 0.29 mm in both DXA scans and plain radiographs, showed a significant correlation with osteoporosis (T-score <-2.5). Conclusion : The bone geometry parameters from either DXA scans or plain radiographs may be used to predict osteoporotic hip fracture with a moderate to high correlation. Plain radiographs are very helpful when DXA scan results are not available. The FNCT parameter has a strong correlation with osteoporosis. Keywords : Bone geometry, Hip fracture, DXA, Plain X-ray, Osteoporosis, BMD
3 citations
Cites background or methods from "Relationship between radiographic f..."
...Plain radiograph Following the DXA scan, a plain radiograph was performed on both hips of all patients in AP view(14)....
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...Many studies suggest that these hip bony geometry calculations can predict the risk of hip fractures(6-14)....
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...1) The distance A to B is the hip axis length, 2) the alpha (α) angle is the femoral neck shaft angle, 3) the distance C + D + E is the femoral neck width, and 4) the distance C plus the distance E is the femoral neck cortical thickness(14,15)....
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...Studies conducted over the past 10 years have also reported that using bone geometry from plain radiographs could predict hip osteoporosis including hip fractures(6,10,14)....
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References
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TL;DR: An increased risk of LBP (including all types) was found in relation to all signs of disc degeneration and sciatic pain with posterior disc bulges, and low back pain is strongly associated with occupation.
Abstract: STUDY DESIGN: Cross-sectional magnetic resonance imaging (MRI) study. OBJECTIVES: To study the relation of low back pain (LBP) to disc degeneration in the lumbar spine. BACKGROUND DATA: Controversy still prevails about the relationship between disc degeneration and LBP. Classification of disc degeneration and symptoms varies, hampering comparison of study results. METHODS: Subjects comprised 164 men aged 40-45 years-53 machine drivers, 51 construction carpenters, and 60 office workers. The data of different types of LBP, individual characteristics, and lifestyle factors were obtained from a questionnaire and a structured interview. Degeneration of discs L2/L3-L5/S1 (dark nucleus pulposus and posterior and anterior bulge) was assessed with MRI. RESULTS: An increased risk of LBP (including all types) was found in relation to all signs of disc degeneration. An increased risk of sciatic pain was found in relation to posterior bulges, but local LBP was not related to disc degeneration. The risks of LBP and sciatic pain were strongly affected by occupation. CONCLUSIONS: Low back pain is associated with signs of disc degeneration and sciatic pain with posterior disc bulges. Low back pain is strongly associated with occupation.
1,034 citations
TL;DR: Comparisons with the results from tissue culture experiments indicated that the observed changes in matrix compressive stress would inhibit disc cell metabolism throughout the disc, and could lead to progressive deterioration of the matrix.
Abstract: volves gross structural disruption as well as cell-mediated changes in matrix composition, but there is little evidence concerning which comes first. Comparatively minor damage to a vertebral body is known to decompress the adjacent discs, and this may adversely affect both structure and cell function in the disc. Methods. In this study, 38 cadaveric lumbar motion segments (mean age, 51 years) were subjected to complex mechanical loading to simulate typical activities in vivo while the distribution of compressive stress in the disc matrix was measured using a pressure transducer mounted in a needle 1.3 mm in diameter. “Stress profiles” were repeated after a controlled compressive overload injury had reduced motion segment height by approximately 1%. Moderate repetitive loading, appropriate for the simulation of light manual labor, then was applied to the damaged specimens for approximately 4 hours, and stress profilometry was repeated a third time. Discs then were sectioned and photographed. Results. Endplate damage reduced pressure in the adjacent nucleus pulposus by 25% 6 27% and generated peaks of compressive stress in the anulus, usually posteriorly to the nucleus. Discs 50 to 70 years of age were affected the most. Repetitive loading further decompressed the nucleus and intensified stress concentrations in the anulus, especially in simulated lordotic postures. Sagittal plane sections of 15 of the discs showed an inwardly collapsing anulus in 9 discs, extreme outward bulging of the anulus in 11 discs, and complete radial fissures in 2 discs, 1 of which allowed posterior migration of nucleus pulposus. Comparisons with the results from tissue culture experiments indicated that the observed changes in matrix compressive stress would inhibit disc cell metabolism throughout the disc, and could lead to progressive deterioration of the matrix. Conclusions. Minor damage to a vertebral body end
734 citations
TL;DR: Examination of individual features revealed that disc height and bulge were highly heritable at both sites, and osteophytes were heritable in the lumbar spine, suggesting an important genetic influence on variation in intervertebral disc degeneration.
Abstract: Objective
Degenerative intervertebral disc disease is common; however, the importance of genetic factors is unknown. This study sought to determine the extent of genetic influences on disc degeneration by classic twin study methods using magnetic resonance imaging (MRI).
Methods
We compared MRI features of degenerative disc disease in the cervical and lumbar spine of 172 monozygotic and 154 dizygotic twins (mean age 51.7 and 54.4, respectively) who were unselected for back pain or disc disease. An overall score for disc degeneration was calculated as the sum of the grades for disc height, bulge, osteophytosis, and signal intensity at each level. A “severe disease” score (excluding minor grades) and an “extent of disease” score (number of levels affected) were also calculated.
Results
For the overall score, heritability was 74% (95% confidence interval [95% CI] 64–81%) at the lumbar spine and 73% (95% CI 64–80%) at the cervical spine. For “severe disease,” heritability was 64% and 79% at the lumbar and cervical spine, respectively, and for “extent of disease,” heritability was 63% and 63%, respectively. These results were adjusted for age, weight, height, smoking, occupational manual work, and exercise. Examination of individual features revealed that disc height and bulge were highly heritable at both sites, and osteophytes were heritable in the lumbar spine.
Conclusion
These results suggest an important genetic influence on variation in intervertebral disc degeneration. However, variation in disc signal is largely influenced by environmental factors shared by twins. The use of MRI scans to determine the phenotype in family and population studies should allow a better understanding of disease mechanisms and the identification of the genes involved.
505 citations
TL;DR: This study of osteo-arthrosis is based on the same survey material as the corresponding paper on rheumatoid arthritis, and a one-in-ten random sample of the population aged 55-64 years in the Lancashire town of Leigh was studied clinically, radiologically, and serologically for all forms of arthritis.
Abstract: This study of osteo-arthrosis, or degenerative joint disease, is based on the same survey material as the corresponding paper on rheumatoid arthritis (Kellgren and Lawrence, 1956). A one-in-ten random sample of the population aged 55-64 years in the Lancashire town of Leigh was studied clinically, radiologically, and serologically for all forms of arthritis. After a detailed clinical examination of the joints, routine x rays were taken of the hands, feet, pelvis, knees, and cervical and lumbar spine, and a blood sample was taken for the sheep cell agglutination test (SCAT). The clinical and radiological part of the survey was 79 per cent. complete. In a previous survey of rheumatic complaints made in the town of Leigh in 1949-50, osteo-arthrosis was diagnosed on clinical grounds more frequently than any other form of rheumatism (Kellgren, Lawrence, and Aitken-Swan, 1953). The prevalence of complaints attributable to osteo-arthrosis was exceptionally high in females over 50 years of age, and in this sex was more often polyarticular and was less closely associated with trauma or occupation than in males. A separate study of patients seen at the University Rheumatism Clinic had shown that women frequently suffer from a polyarticular form of osteo-arthrosis which has a distinct symptomatology, course, and pattern of joint involvement. This condition has been described as \"primary generalized osteo-arthritis\" (Kellgren and Moore, 1952). The present study was designed to obtain more precise information about this condition, and to investigate causative factors in osteo-arthrosis in general. For details of sampling and for the method of conducting the survey, the paper on rheumatoid arthritis should be consulted. At the clinical examination all persons seen were given a grading for rheumatoid arthritis and for local and generalized osteo-arthrosis. The x rays were later read by two observers in consultation. Problems of observer
466 citations
"Relationship between radiographic f..." refers background in this paper
...However, radiographic abnormalities such as intervertebral disc space narrowing, spinal osteophytes, Schmorl’s nodes, transitional vertebrae, and accentuated lumbar lordosis have been commonly cited as significant findings in patients with low-back pain [6, 10, 20, 22, 46]....
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437 citations
"Relationship between radiographic f..." refers background in this paper
...The importance of mechanical factors has been emphasised by experiments on cadaver spines with both a severe single event and relentless loading [1, 2, 11, 27, 45]....
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