Prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women

BACKGROUND: The aims of the present study were to examine the prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women. METHODS: We examined 598 of the 1513 inhabitants of Miyagawa village aged > or = 65 years (393 women, 205 men). Baseline data, obtained with standard questionnaires, included information on age, past history, sports activity, working, knee pain, smoking, and intakes of alcohol and milk. Bone mineral density of the forearm was measured using dual energy X-ray absorptiometry. Anteroposterior radiographs of both knees were graded for osteoarthritis using the Kellgren-Lawrence grading system. Definite osteoarthritis was defined as a grade of 2 or higher. We used logistic regression analysis by the stepwise method to determine the risk factors for radiographic knee osteoarthritis. RESULTS: The prevalence of definite radiographic knee osteoarthritis was 30.0% overall: 17.7% in men and 36.5% in women. The prevalence of symptomatic knee osteoarthritis was 21.2% overall: 10.7% in men and 26.7% in women. There were significant differences in the risk of radiographic knee osteoarthritis with body mass index (BMI), sex, age, and bone mineral density (BMD). CONCLUSIONS: The prevalence of definite radiographic knee osteoarthritis was 30.0% and that of symptomatic knee osteoarthritis was 21.2%. We found that higher BMI, female sex, older age, and higher BMD were significantly associated with an increased risk for radiographic knee osteoarthritis.     

Influence of Age and Sex on Vertebral Shape Indices Assessed by Radiographic Morphometry

Vertebral shape indices (VSI) assessed by radiographic morphometry are currently used to define vertebral fractures in clinical trials and epidemiologic studies on osteoporosis. However, there is little information concerning the influence of sex or age on VSI. Furthermore, previous reports on the variation of VSI with age showed conflicting results. The aim of this study was to assess the influence of sex and age on VSI in order to better define reference values for the clinical and epidemiologic evaluation of vertebral osteoporotic fractures. Measurements were performed on thoracic and lumbar spine radiographs from 50 men and 50 women (age range 25–75 years) without evidence of osteoporotic, degenerative or other disease-related vertebral deformity. The anterior (AH), middle (MH) and posterior (PH) heights of each vertebral body from T4 to L5 were measured and VSI were calculated as follows: wedging = (AH minus PH) divided by PH; concavity = (MH minus PH) divided by PH. Wedging and concavity, especially at the mid and lower thoracic spine, increased significantly with age in both sexes. We also demonstrated that VSI at the lumbar spine were significantly dependent on gender, with greater values of wedging and concavity in men than in women. Consequently, reference values used for the definition of vertebral osteoporotic fractures assessed by radiographic morphometry should take into account both sex and age effects. Received: 15 October 1998 / Accepted: 18 May 1999     

Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.     

Exclusion of focal vertebral artifacts from spine bone densitometry and fracture prediction: a comparison of expert physicians, three computer algorithms, and the minimum vertebra.

Expert physicians and automated methods for the exclusion of vertebral levels in DXA scans containing focal artifacts were compared. All methods of vertebral exclusion led to a small improvement in fracture prediction. Computer algorithms performed at least as well as physicians. INTRODUCTION: Lumbar spine DXA is often confounded by focal artifacts. Clinical rules and automated methods for vertebral exclusion have been proposed, but their concordance, effect on diagnosis, and fracture prediction is unknown. MATERIALS AND METHODS: We analyzed clinical DXA scans of the lumbar spine (20,478 women and 1534 men) performed from 1998 to 2002 (Province of Manitoba, Canada). Longitudinal health service records were assessed for the presence of nontrauma fracture codes after BMD testing. The effect of vertebral exclusions by expert physicians and several automated methods on diagnosis and prediction of incident fractures was compared. RESULTS: Vertebral exclusions were reported by physicians in over one quarter of the scans (31% of women and 29% of men). All methods of vertebral exclusion significantly decreased the mean spine T-score and increased the proportion of women designated as osteoporotic. kappa values and ROC area under the curve (AUC) for physician-computer agreement in the identification of abnormal scans indicated fair to moderate agreement in both women and men. Compared with no vertebral exclusions, a small increase in the hazard ratio and AUC for spine fracture and osteoporotic fracture prediction was seen after physician and computer exclusions. Compared with physician exclusions, AUC for prediction of osteoporotic fractures in men increased significantly with one computer algorithm (p = 0.004). The minimum vertebral T-score enhanced fracture prediction compared with no exclusions but approximately doubled the prevalence of osteoporotic categorization. CONCLUSIONS: We observed fair to moderate agreement between the physician and computer methods for vertebral level exclusion. All methods of vertebral exclusion led to a small improvement in fracture prediction using the lumbar spine measurement. The automated algorithms performed at least as well as physicians when fractures were used as the endpoint.     

The Health Consequences of Vertebral Deformity in Elderly Chinese Men and Women

The following health consequences of vertebral deformity in Hong Kong elderly Chinese men and women were studied: the prevalence of back pain, disability due to back pain, and low morale. Lateral X-ray films were taken of the thoracic and lumbar spine of 796 community-dwelling Chinese subjects (396 men, 400 women) (aged 70–79). Subjects with one or more definitely deformed vertebra (reduction in vertebral height 3 SD or more below the mean) were classified as definite cases, those with one or more mildly deformed vertebra (reduction in vertebral height 2–2.99 SD below the mean) as mild cases, and the rest as controls. The prevalence and consequences of back pain were measured by a standardized questionnaire, and morale was measured by the Geriatric Morale Score. The relative risk (RR) and 95% confidence interval (CI) of having back pain and being depressed were calculated by logistic regression. Classifications included 16% of men and 30% of women as definite cases, 37% of men and 35% of women as mild cases, and 47% of men and 35% of women as controls. The relative risk (RR) of back pain was 2.3 (95% CI 1.4–3.9) (P < 0.05) in women with definite deformity and 1.5 (95% CI 0.9–2.5) (P > 0.05) in women with mild deformity, as compared with controls. Sixty-four percent of all men had back pain. This prevalence was much higher than figures obtained in a previous survey on low back pain. The prevalence of back pain did not differ by deformity status, but more men with vertebral deformity were on analgesic. There was no significant association between disability due to back pain and vertebral deformity in women. The RR for having a low morale score (of 5 and below) was 2.3 (95% CI 1.3–4.1) (P < 0.05) in women with mild deformity; men with vertebral deformity did not have a low morale. It was concluded that vertebral deformity was associated with significant back pain and psychological morbidity in elderly Chinese women. Although men with vertebral deformity did not report more back pain, more were on analgesics than controls. Received: 2 July 1997 / Accepted: 8 January 1998     

Prevalence of Vertebral Deformity and its Associations with Physical Impairment among Japanese Women: The Hizen-Oshima Study

Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment, but the clinical significance of vertebral deformities remains uncertain. We examined the prevalence of vertebral deformity and associations of vertebral deformities and other characteristics with physical functioning among 584 Japanese women ages 40 to 89 years. Lateral spine radiographs were obtained and radiographic vertebral deformities were assessed by quantitative morphometry, defined as vertebral heights more than 3 SD below the normal mean. A self-administered questionnaire was used to survey participants about difficulty in performing selected basic and instrumental activities of daily living (ADL). Overall, 15% of women had at least one vertebral deformity, and 8% had 2 or more. The prevalence of vertebral deformities increased progressively with age. Half of women ages 80 and over had vertebral deformities. Impaired function was defined as difficulty performing 3 or more ADLs. After adjusting for age, the odds of impaired function were increased by 1.4 times (95% CI: 0.7, 2.9) in women with a single vertebral deformity, and 3.1 times (1.4, 6.8) in those with two or more deformities. Additional adjustment for number of painful joints, number of comorbidities, body mass index, and back pain did not materially alter these findings. In conclusion, women with multiple vertebral deformities had significantly greater impaired function. The association was independent of age, back pain and the number of painful joints, suggesting that deformities may impair function even when back pain is not present. Received: 29 October 2001 / Accepted: 11 April 2002     

Vertebral fractures in Beijing, China: the Beijing Osteoporosis Project.

Women in China have much lower risk of hip fracture than women in Europe or North America but their risk of vertebral fractures is not known. Lateral spine radiographs, hip and lumbar spine bone density, and potential risk factors for and consequences of vertebral fractures were assessed in a random sample of 402 women age 50 years or older living in Beijing, China. The prevalence of vertebral fractures, defined by vertebral morphometry, increased from 5% (95% CI, 1-9%) in 50- to 59-year olds to 37% (27-46%) among women age 80 years or older. The age-standardized prevalence of vertebral fractures was 5.5% lower than found by similar methods for women in Rochester, MN, U.S.A. Each SD lower spine bone mineral density (BMD) was associated with a 2.4-fold (1.7-3.5) increased odds of having a vertebral fracture. Women with a history of heavy physical labor had a lower risk of vertebral fractures. Vertebral fractures were associated with decreased height loss and limited physical function but not chronic back pain. Women in Beijing, China have lower bone density and a slightly lower rate of vertebral fracture than white women in the United States. Low bone density and more sedentary occupations increase the risk of fracture in women living in urban China.     

Misleading history of pain location in 51 patients with osteoporotic vertebral fractures

The aim of this study was to investigate associations between the location of osteoporotic vertebral fractures and the patient’s localization of pain. Fifty-one consecutive patients (m 6, f 45; average age 74.8 years) with diagnosed osteoporotic vertebral fractures between T8 and L2 were included in the study. Exclusion criteria were fractures above T8 and below L2, spondylolisthesis, disc herniations, tumors, infections, and instability. Pain location was assessed by pain drawing, subdivided into thoracic, lumbar, and thoracic plus lumbar pain areas, and pain intensity using a 101 numeric rating scale. Furthermore, the onset of back pain and the lack or the indication of a trigger event at the onset of pain were documented. Only four of 20 patients with thoracic fractures reported thoracic pain, while the other 16 (80%) reported only lumbar pain. The location of the fracture and the patient’s pain report were not related (Cohens Kappa=0.046; P=0.438). Patients with thoracic or lumbar osteoporotic fractures report pain mainly in the lumbosacrogluteal area. Therefore, the complaint of low back pain (LBP) in persons at risk for osteoporotic fractures may require both thoracic and lumbar X-rays. LBP patients with a suspect history of an osteoporotic vertebral fracture should also be given an X-ray of the thoracic and lumbar spine. Patients with a thoracic vertebral fracture had more severe pain than patients with a lumbar vertebral fracture. Onset not related to a fall or a false movement related to a significantly longer pain duration.     

Association between self-reported prior wrist fractures and risk of subsequent hip and radiographic vertebral fractures in older women: a prospective study.

In this large prospective cohort study of elderly women, the relationships between prior wrist fracture and incident hip and radiographic vertebral fractures were significantly attenuated when adjusted for BMD. This study suggests that BMD thresholds for drug therapy to prevent osteoporotic fracture should be only modestly adjusted in those with prior wrist fracture compared with those without prior wrist fracture. Validation of such an approach would require intervention trials in patients with prior wrist fracture. INTRODUCTION: Prior wrist fracture has been identified as a risk factor for incident hip and vertebral fractures and proposed as a criterion for determining who should be offered drug therapy to prevent osteoporotic fracture, even if their hip BMD T score is > -2.5. Previously published studies of the relationships between prior wrist fracture and incident hip and vertebral fractures did not adjust for BMD. MATERIALS AND METHODS: We ascertained prior history of wrist fracture since age 50, measured calcaneal and hip BMD, and performed lateral spine films in a cohort of 9704 elderly community-dwelling women, and then followed them prospectively for incident vertebral and hip fractures. Incident vertebral fractures were defined by morphometry using lateral spine radiography at the first examination and an average of 3.7 years later. Incident hip fractures were confirmed with radiographic reports over a mean follow-up period of 10.1 years. RESULTS: Prior wrist fracture was associated with an age-adjusted 72% increased odds of incident radiographic vertebral fracture (odds ratio [OR], 1.72; 95% CI, 1.31-2.25). After adjustment for calcaneal BMD, the association of prior wrist fracture with incident radiographic vertebral fracture was attenuated (OR, 1.39; 95% CI, 1.05-1.83). Prior wrist fracture was also associated with an age-adjusted 43% excess rate of incident hip fracture (hazards ratio [HR], 1.43; 95% CI, 1.17-1.74). After adjustment for hip BMD, the association of prior wrist fracture with rate of incident hip fracture was no longer statistically significant (HR, 1.12; 95% CI, 0.92-1.38). CONCLUSION: In elderly women, prior wrist fracture is a risk factor for radiographic vertebral fracture independent of BMD. The association between prior wrist fracture and incident hip fracture is largely explained by hip BMD. Modest adjustment of BMD drug treatment thresholds for prevention of osteoporotic fractures in those with prior wrist fracture compared with those without prior wrist fracture may be reasonable, but validation of such an approach would require intervention trials in patients with prior wrist fracture.     

Vertebral Fracture Assessment (VFA) With a Densitometer Predicts Future Fractures in Elderly Women Unselected for Osteoporosis

Low radiation dose imaging of the lateral spine acquired with a bone densitometer for vertebral fracture assessment (VFA) has great potential for clinical use. We have undertaken an evaluation of VFA in a prospective population cohort of elderly women to examine the prevalence of vertebral fractures, their ability to predict incident fractures, and their use in targeting therapy. Women (n = 5157) ≥75 yr of age living in the general community in the United Kingdom underwent posteroanterior and lateral imaging of the spine (T₄–L₄) with a densitometer (Hologic QDR4500A) at entry to a randomized, double‐blind, controlled trial of 800 mg oral clodronate (Bonefos) or matching placebo daily over 3 yr. The women were identified from general practice registers and recruited by letter of invitation regardless of skeletal status. The proportion of vertebrae interpretable varied from 98.2% at T₁₂ to 57.1% at T₄, with >92% interpretable at levels between T₈ and L₃. As judged by BMD at the total hip, 19.6% of the women had osteoporosis, and the prevalence of vertebral fracture was 14.5%. Women with one or more vertebral fractures had a relative risk (RR) for incident osteoporotic fractures of 2.01 (95% CI, 1.64–2.47). The RR for hip fractures was 2.29 (95% CI, 1.63–3.21). After adjustment for age, femoral neck BMD, weight, and treatment, the RR was 1.50 (95% CI, 1.21–1.86) for osteoporotic fractures, with similar results for hip fractures (RR, 1.41; 95% CI, 0.99–2.02). For women with two or more vertebral fractures, the adjusted RRs were 1.97 (95% CI, 1.24–2.72) and 1.86 (95% CI, 1.14–3.03) for osteoporotic and hip fractures, respectively. We conclude that VFA can frequently detect vertebral fractures in a population cohort of elderly women. These fractures, like radiographic fractures, predict future clinical fractures independent of age, weight, and BMD. Having multiple vertebral fractures was associated with greater risk of incident osteoporotic fractures and hip fractures.     

Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men

Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual‐energy X‐ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C‐statistic and with a categorical net reclassification improvement index, using 10‐year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10‐year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non‐cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non‐cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other and FRAX 10‐year fracture risks, and these data support their use in conjunction with FRAX for fracture risk assessment in older men. © 2015 American Society for Bone and Mineral Research.     

Clinical utility of spine bone density in elderly women.

It is common clinical practice to obtain a bone density measurement at both the hip and spine to evaluate osteoporosis. With aging, degenerative changes in the lumbar spine may elevate the bone mineral density (BMD) results giving false assurances that the fracture risk at the spine is low. We examined the association of spine osteoarthritis and bone mineral density in 1082 community-dwelling ambulatory older women aged 50-96 years who participated in a 1992-1996 osteoporosis research clinic visit. The BMD was measured at the hip and posteroanterior (PA) and lateral lumbar spine using dual energy X-ray absorptiometry (DXA). Spine osteoarthritis was identified on the PA lumbar spine DXA images by a musculoskeletal radiologist. Forty percent of women had evidence of spine osteoarthritis (OA). Women with spine OA had a mean age of 77.4 yr (95% confidence interval [CI]: 76.5-78.2), were significantly older than women without spine OA (mean age, 66.8 yr; 95% CI: 65.9-67.7), and were more likely to have prevalent radiographic fractures (14.2% vs. 9.5%; p<0.05). Age-adjusted BMD at the femoral neck, total hip, PA spine, and lateral spine was significantly higher in women with spine OA. Women with spine OA were more likely to have osteoporosis by the World Health Organization classification at the femoral neck and total hip than those without spine OA, but less likely based on the PA spine (14.4% vs. 24.5%). Despite higher BMD levels, women with OA of the lumbar spine had higher prevalence of osteoporosis at the hip and more radiographic vertebral fractures. In elderly women 65 yr and older who are likely to have spine OA, the DXA measurement of the spine may not be useful in assessing fracture risk, and DXA of the hip is recommended for identification of osteoporosis.     

Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly

Summary

The prevalence and risk factors of radiographic vertebral fracture were determined among Brazilian community-dwelling elderly. Vertebral fractures were a common condition in this elderly population, and lower hip bone mineral density was a significant risk factor for vertebral fractures in both genders.

Introduction

The aim of the study was to estimate the prevalence of radiographic vertebral fracture and investigate factors associated with this condition in Brazilian community-dwelling elderly.

Methods

This cross-sectional study included 943 elderly subjects (561 women and 382 men) living in São Paulo, Brazil. Thoracic and lumbar spine radiographs were obtained, and vertebral fractures were evaluated using Genant's semiquantitative method. Bone mineral density (BMD) was measured by dual X-ray absorptiometry, and bone biochemical markers were also evaluated. Female and male subjects were analyzed independently, and each gender was divided into two groups based on whether vertebral fractures were present.

Results

The prevalence of vertebral fracture was 27.5% (95% CI 23.8–31.1) in women and 31.8% in men (95% CI 27.1–36.5) (P?=?0.116). Cox regression analyses using variables that were significant in the univariate analysis showed that age (prevalence ratio?=?1.03, 95% CI 1.01–1.06; p?=?0.019) and total femur BMD (PR?=?0.27, 95% CI 0.08–0.98; p?=?0.048) were independent factors in predicting vertebral fracture for the female group. In the male group, Cox regression analyses demonstrated that femoral neck BMD (PR?=?0.26, 95% CI 0.07–0.98; p?=?0.046) was an independent parameter in predicting vertebral fractures.

Conclusions

Our results suggest that radiographic vertebral fractures are common in Brazilian community-dwelling elderly and that a low hip BMD was an important risk factor for this condition in both genders. Age was also significantly correlated with the presence of vertebral fractures in women.     

Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study.

In elderly men and women, asymptomatic vertebral deformity was found to be associated with subsequent risk of symptomatic fractures, particularly vertebral fracture, and increased risk of mortality after a fracture. INTRODUCTION: Vertebral deformity is associated with an increased risk of fracture and mortality. However, it is unclear whether the three events of vertebral deformity, fracture, and mortality are linked with each other and what role BMD plays in these linkages. MATERIALS AND METHODS: Vertebral deformity was determined from quantitative analysis of thoracolumbar spine X-rays in 300 randomly individuals (114 men and 186 women) 60 years of age (as of mid-1989), who were randomly selected from the prospective Dubbo Osteoporosis Epidemiology Study. Incidence of atraumatic fractures and subsequent mortality were ascertained from 1989 to 2003. Cox's proportional hazards model was used to determine the association between asymptomatic vertebral deformities, osteoporotic fractures, and risk of mortality. RESULTS: The prevalence of asymptomatic vertebral deformity was 31% in men and 17% in women. During the follow-up period, subjects with vertebral deformity had a significantly higher risk of any fracture than those without vertebral deformity (44% versus 29%; hazards ratio [HR], 2.2; 95% CI, 1.4-3.7), particularly symptomatic vertebral fracture (relative risk [RR], 7.4; 95% CI, 3.2-17.0). Mortality rate was highest after a symptomatic fracture among those with vertebral deformity (HR, 9.0; 95% CI, 3.1-26.0). These associations were independent of age, sex, and BMD. CONCLUSION: Vertebral deformity was a strong predictor of subsequent risk of fractures, particularly symptomatic vertebral fracture, and may modify fracture-associated mortality in both elderly men and women.     

The relationship between lumbar lordosis and radiologic variables and lumbar lordosis and clinical variables in elderly,African-American women

Several authors have hypothesized that there is a link between lumbar lordosis and low back pain. These relationships have not been previously described in a sample consisting exclusively of elderly, African-American women. The purpose of this study was to describe the relationship between lumbar lordosis and radiologic variables and lumbar lordosis and clinical variables in elderly, African-American women. A total of 475 African-American women enrolled in the multicenter Study of Osteoporotic Fractures participated in this ancillary, cross-sectional, study of lumbar lordosis. These women received lumbar spine radiographs and completed a questionnaire on low back pain and its impact on their daily lives. Lumbar lordosis tertiles were created based on radiographic measurements. Comparisons were made between the tertiles for differences in radiologic and clinical variables. Significant differences (p < 0.0025) were observed between the lordosis tertiles and the presence of spondylolisthesis, intervertebral disc space, and vertebral wedging. No significant differences were observed between the lordosis tertiles for the occurrence of low back pain, symptoms associated with low back pain, and disability experienced from low back pain. The degree of lumbar lordosis was associated with radiologic variables but was not associated with symptoms or decreased function from low back pain. These findings question the clinical utility of the lumbar lordosis measurement in elderly, African-American women.     

Association of Incident,Clinically Undiagnosed Radiographic Vertebral Fractures With Follow‐Up Back Pain Symptoms in Older Men: the Osteoporotic Fractures in Men (MrOS) Study

Prior data in women suggest that incident clinically undiagnosed radiographic vertebral fractures (VFs) often are symptomatic, but misclassification of incident clinical VF may have biased these estimates. There are no comparable data in men. To evaluate the association of incident clinically undiagnosed radiographic VF with back pain symptoms and associated activity limitations, we used data from the Osteoporotic Fractures in Men (MrOS) Study, a prospective cohort study of community‐dwelling men aged ≥65 years. A total of 4396 men completed spine X‐rays and symptom questionnaires at baseline and visit 2, about 4.6 years later. Incident clinical VFs during this interval were defined by self‐reported clinical diagnosis plus community imaging showing a centrally adjudicated ≥1 increase in semiquantitative (SQ) grade in any thoracic or lumbar vertebra versus baseline study X‐rays. Incident radiographic VFs (≥1 increase in SQ grade between baseline and visit 2 study X‐rays) were categorized as radiographic‐only (not clinically diagnosed) or radiographic plus clinical (also clinically diagnosed). Multivariable‐adjusted log binomial regression was used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). Men with incident radiographic plus clinical VF were most likely to have back pain symptoms and associated activity limitation at follow‐up. However, versus men without incident VF, those with incident radiographic‐only VF also were significantly more likely at follow‐up to report any back pain (70% versus 59%; PR, 1.2 [95% CI, 1.1 to 1.3]), severe back pain (8% versus 4%; PR, 1.9 [95% CI, 1.1 to 3.3]), bother from back pain most/all the time (22% versus 13%; PR, 1.7 [95% CI, 1.3 to 2.2]), and limited usual activity from back pain (34% versus 18%; PR, 1.9 [95% CI, 1.5 to 2.4]). Clinically undiagnosed, incident radiographic VFs were associated with an increased likelihood of back pain symptoms and associated activity limitation. Results suggest incident radiographic‐only VFs often were symptomatic, and were associated with both new and worsening back pain. Preventing these fractures may reduce back pain and related disability in older men. © 2017 American Society for Bone and Mineral Research.     

Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group

Vertebral fractures are the most common osteoporotic fracture and are associated with significant pain and disability. Prior vertebral fracture and low bone mineral density (BMD) are strong predictors of new vertebral fracture. Using data from 6082 women, ages 55-80 years, in the Fracture Intervention Trial (a randomized, placebo-controlled trial of the antiresorptive agent, alendronate), we explored the association of the number of prior vertebral fractures with the risk of new fractures and whether this association is influenced by the spinal location of fractures. The risk of future vertebral fractures increased with the number of prevalent fractures, independently of age and BMD; in the placebo group, more than half of the women with five or more fractures at baseline developed new vertebral fractures, compared to only 3.8% of women without prior vertebral fractures. The magnitude of association with an increased risk of future vertebral fractures was equal for prevalent fractures located in either the "lower" (T12-L4) (relative risk [RR] = 2.9; 95% CI = 1.9, 3.6) or "upper" (T4-10) spine (RR = 2.6; 95% CI = 1.9, 3.6). We found no evidence that the effectiveness of alendronate in reducing the risk of future vertebral fracture was attenuated in women with up to five or more prevalent fractures, or that it varied by the location of prevalent fractures. However, prevalent vertebral fractures in any location were more strongly associated with risk of new fractures in the upper (RR = 5.2; 95% CI = 3.2, 8.3) than in the lower spine (2.3; 1.6, 3.3). In addition, each 1 SD decrease in spinal BMD was associated with a 2.1 (1.7, 2.6) times greater odds of new fracture in the upper spine, compared with 1.5 (1.3, 1.8) for the lower spine. These findings suggest that, in older women, osteoporosis may be a stronger risk factor for new fractures in the upper (vs. lower) thoracolumbar spine, although we found no evidence that the location of prior fractures should influence treatment decisions. Physicians should recognize that prior vertebral fractures are a strong risk factor for future fractures, and consider treating such patients to reduce their risk of subsequent fractures.     

Bone mineral density and vertebral fracture history are associated with incident and progressive radiographic knee osteoarthritis in elderly men and women: the Rotterdam Study

OBJECTIVE: To study the association between baseline femoral neck and lumbar spine bone mineral density (BMD), prevalent fractures and incident and progressive radiographic osteoarthritis (ROA) of the knee in men and women. METHODS: A sample of 1403 subjects (829 women and 574 men) was drawn from the Rotterdam Study, a prospective population-based cohort study of the elderly. Incidence and progression of ROA in quartiles of femoral neck (FN) and lumbar spine (LS) BMD were determined using the Kellgren score, and separate analyses were made for men and women. Furthermore, incidence and progression of ROA were compared in subjects with and without a prevalent vertebral or non-vertebral fracture at baseline. RESULTS: The incidence of knee ROA of subject in the highest FN BMD (10.5%) and LS BMD (14.3%) was significantly higher than of those in the lowest quartiles (3.4% and 3.3% respectively), with corresponding adjusted odds ratios (95% confidence interval) of 2.8 (1.2-6.8) and 4.7 (2.1-10.7). The same trend was seen in the association between LS BMD and the progression of knee ROA, but no association was found between FN BMD and progression of ROA. Separate analyses for men and women both showed significant increased risks in the presence of high baseline BMD, with higher odds ratios in men than in women but larger confidence limits due to lower number of cases in men. Combined incidence and progression of knee ROA in subjects with a prevalent vertebral but not with a prevalent non-vertebral fracture at baseline was 8 times lower than subject without a fracture, independent of baseline BMD. CONCLUSIONS: High systemic BMD at baseline is associated with increased incidence and progression of knee ROA in both men and women, while a prevalent vertebral fracture has a protective effect.     

Back problems among postmenopausal women taking estrogen replacement therapy: the study of osteoporotic fractures.

STUDY DESIGN: Cross-sectional and prospective. OBJECTIVES: To investigate the association between estrogen replacement therapy use, back pain, and back function in a large cohort of elderly women. BACKGROUND: Several studies have suggested that women who use estrogen replacement therapy may be more likely to experience back pain than those who do not. However, the relationships between estrogen replacement therapy, back pain, and impaired back function have not been clearly delineated. METHODS: At baseline information on estrogen replacement therapy use, functional status, back pain and function, and general lifestyle variables was obtained from 7209 elderly white women (mean age 71 years)enrolled in the Study of Osteoporotic Fractures. Lateral radiographs of the lumbar and thoracic spine were taken at baseline and at the third clinic visit, an average of 3.7 years after the baseline visit. Bone mineral density at the hip and spine was measured approximately 2 years after baseline. Follow-up information on back pain and function was also obtained at the third clinic visit. RESULTS: A total of 1039 (14.4%) women were using estrogen replacement therapy at baseline, 2016(28.0%) reported former use, and 4154 (57.6%) had never used estrogen replacement therapy. Compared with never-users, a statistically significant higher percentage of current estrogen users reported clinical back pain (52.7% vs. 43.4%) and back impairment (12.3% vs. 9.2%) at baseline and at the follow-up visit (pain 50.8% vs. 41%; impairment 16.0% vs. 12.1%). This occurred despite a higher prevalence of vertebral fractures in never-users of estrogen at the baseline visit. Current and former estrogen users without vertebral fractures had statistically significant higher likelihoods of having back pain and back dysfunction at both the baseline and third follow-up visit. The increased likelihood of back pain and back impairment in current and former estrogen users remained despite statistical adjustment for age, vertebral fracture, body mass index,smoking history, parity, exercise, arthritis, and diabetes in multivariate models. The relative risk (95%confidence interval) for impaired back function in former and current users at follow-up was 1.1 (0.9, 1.3) and 1.6 (1.3, 2.0), respectively. CONCLUSIONS: Our results indicate that postmenopausal estrogen use is associated with an increased likelihood of back pain and impaired back function in elderly white women.