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: It is suggested that subjects with shorter variable numbers of tandem repeat length of the aggrecan gene have a risk of having multilevel disc degeneration develop at an early age.
Abstract: Study Design. A case-control study using magnetic resonance imaging findings and a polymerase chain reaction assay to investigate the association between aggrecan gene polymorphism and lumbar disc degeneration. Objective. To analyze whether the aggrecan gene polymorphism is related to lumbar disc disease in young women. Summary of Background Data. It has been suggested that a genetic factor or familial predisposition contributes to the development of lumbar disc herniation. However, the precise genetic component related to disc disease remains unclear. Recently, a polymorphism has been identified in the region of the human aggrecan gene. The expressed variable numbers of tandem repeat polymorphism occur in the highly conserved repeat region. Methods. The participants were 64 young women with or without low back problems. Magnetic resonance imaging was used to evaluate the degeneration and herniation of the intervertebral disc. Genomic deoxyribonucleic acid was extracted from all participants. A polymerase chain reaction assay was carried out to detect the alleles of the aggrecan gene. The association of intervertebral disc degeneration and herniation with the distribution of the aggrecan gene alleles was analyzed. Results. Findings showed an overrepresentation of alleles with small numbers of repeats in subjects with multilevel disc degeneration, thus indicating a significant distribution difference. There also was a significant difference between the distribution of alleles and the severity of disc degeneration. No significant association was found between any of the alleles either in number or type of disc herniation. Conclusions. The current study showed that multilevel and severe disc degeneration was present in the participants with shorter variable numbers of tandem repeat length of the aggrecan gene. This suggests that subjects with shorter variable numbers at tandem repeat length of the aggrecan gene have a risk of having multilevel disc degeneration develop at an early age.
261 citations
"Relationship between radiographic f..." refers background in this paper
...In addition, some authors indicate that low back pain has a familial component [4, 44], and in some studies it has been shown to be influenced by specific genetic risk factors such as COL9A1 [34, 38], aggrecan [18], vitamin D receptor [16, 19, 34, 47], and matrix metalloprotease-3 [34]....
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TL;DR: By measurement of intradiscal pressure in vitro, the hydrostatic properties of the nucleus pulposus of normal lumbar intervertebral disc was established and the stress distribution within normal discs subjected to vertical load was explained, demonstrating the high tangential strains occurring in the posterior part of the annulus fibrosus.
Abstract: By measurement of intradiscal pressure in vitro, the hydrostatic properties of the nucleus pulposus of normal lumbar intervertebral disc was established. The stress distribution within normal discs subjected to vertical load was also explained, demonstrating the high tangential strains occurring in the posterior part of the annulus fibrosus. Intravitally performed measurements of disc pressure have demonstrated how the load on the lumbar disc varies according to the position of the subject's body. Compared to the pressure or load in the upright standing position, reclining reduces the pressure by 70%, while unsupported sitting increases the load by 40% and forward leaning and weight lifting by more than 100%. Similar relatively large augmentations of the load were observed in subjects performing various commonly used muscle-strengthening exercises. Measurement of intradiscal pressure is instrumental in explaining, from a mechanical point, the occurrence of posterior ruptures in the lumbar discs, and provides a basis for the rational treatment of patients with low-back pain in so far as these exhibit increase of pain on increased mechanical loads. For the majority of patients with low-back pain, the cause is unknown, although most evidence so far presented links the lumbar intervertebral disc to the pain syndromes. Results of recent studies have shown that both chemical and mechanical factors are probably of importance. So far we cannot successfully treat the chemical part of the disc syndrome. Since all our patients exhibit more pain when the spine is mechanically loaded, knowledge gained from intravital disc-pressure measurements provides a basis for successfully treating the mechanical part of the condition. Since none of the frequently prescribed and more spectacular remedies has ever been proved statistically superior to any of the others, it is most fair to our patients and to ourselves to use simpler, less expensive, and less dangerous programmes, such as bed-rest, administration of salicylates, and proper ergonomic advice. Based on a scientific approach, the low-back-pain school is intended to help the patient to be able to cope with these back troubles, to avoid excess therapy, and to decrease the cost both for the individual and for Society.
247 citations
TL;DR: This investigation provides the first in vitro model of disc prolapse that reliably ruptures discs under physiologically reasonable stress and supports the hypothesis that intervertebral disc Prolapse is peripheral in origin.
Abstract: Lumbar intervertebral disc herniation is thought to be related to senescent changes in the nucleus pulposus except in rare instances of trauma. This investigation provides the first in vitro model of disc prolapse that reliably ruptures discs under physiologically reasonable stress. Fourteen vertebral motion segments with intact posterior elements were loaded repetitively at 1.5 Hz in a combination of flexion (7 degrees), rotation (less than 3 degrees), and compression (1,334 N) for an average of 6.9 hours (range, 3.0-13.0 hours) in a materials testing machine. Loading was terminated when reaction force leveled off for more than 1 hour. Ten discs failed through annular protrusions, and four failed by nuclear extrusion through annular tears, supporting the hypothesis that intervertebral disc prolapse is peripheral in origin. The annulus fibrosus is the site of primary pathologic change.
233 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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TL;DR: This hypothesis was strengthened by the identification of two collagen IX alleles associated with sciatica and lumbar disc herniation, and disc degeneration has been shown to be related to an aggrecan gene polymorphism, a vitamin D receptor and matrix metalloproteinase-3 gene alleles.
Abstract: Lumbar disc disease (LDD) is a common musculoskeletal disease affecting about 5% of all individuals. It is characterized by lumbar disc herniation, which causes nerve root irritation, either mechanically or via inflammatory mediators, and results in radiating pain, known as sciatica. Numerous studies have been conducted to identify the causes and risk factors for LDD. Lifting heavy loads, torsional stress and motor vehicle driving are among the best-identified environmental risk factors. However, it has become evident recently from family and twin studies that genetic factors may also be important in LDD. This hypothesis was strengthened by the identification of two collagen IX alleles associated with sciatica and lumbar disc herniation. In addition, disc degeneration has been shown to be related to an aggrecan gene polymorphism, a vitamin D receptor and matrix metalloproteinase-3 gene alleles.
228 citations
"Relationship between radiographic f..." refers background in this paper
...In addition, some authors indicate that low back pain has a familial component [4, 44], and in some studies it has been shown to be influenced by specific genetic risk factors such as COL9A1 [34, 38], aggrecan [18], vitamin D receptor [16, 19, 34, 47], and matrix metalloprotease-3 [34]....
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TL;DR: The influence of spinal osteophytes on lumbar BMD in postmenopausal women is substantially less than that in men and is, therefore, unlikely to interfere with BMD estimation in most subjects.
Abstract: The assessment of vertebral bone mineral density (BMD) in the anterio-posterior projection has become widely used in the management and prevention of osteoporosis. Recently, it has been demonstrated that the presence of spinal osteophytes has a major impact on measured BMD in men, thus casting doubt on the value of these BMD measurements. We have assessed the impact of osteophytic and aortic calcification on spinal and femoral BMD measurements in 130 normal postmenopausal women, aged 45-71 yr. Lateral lumbar spine radiographs were obtained in all subjects and graded separately (0-3) for osteophytes and aortic calcification. Both forms of calcification increased with age, and BMD of all sites was correlated positively with body weight and negatively with age. The correlation coefficients between BMD and calcification scores were nonsignificant. Multiple regression analysis, including weight, age, and calcification scores, demonstrated a small but significant effect of osteophyte score on lumbar BMD (partial r2 = 0.04; P = 0.012) and a similar trend for Ward's triangle and the trochanteric region (partial r2 = 0.02; P less than 0.06). The aortic calcification score remained nonsignificant. It is concluded that the influence of spinal osteophytes on lumbar BMD in postmenopausal women is substantially less than that in men and is, therefore, unlikely to interfere with BMD estimation in most subjects. The relationship between proximal femoral BMD and osteophyte score suggests a real relationship between skeletal density and degenerative joint disease, as has been demonstrated by others.
210 citations
"Relationship between radiographic f..." refers background in this paper
...Although osteophytes at the lumbar spine have been associated with an increase in bone mass at the spine, this may in part be the result of technical factors — osteophytes cannot be distinguished from vertebral bone mineral using bone mineral density area measurements [5, 8, 12, 15, 23, 26, 29, 30, 33, 40, 43, 48, 50]....
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...Most studies looking at the relationship between disc degeneration and BMD at the spine and hip have been undertaken in women [12, 15, 26, 29, 43] with few data in men [14, 15, 23]....
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