Abstract
BackgroundSeveral studies have observed an inverse relationship between osteoporosis and spinal osteoarthritis, the latter being considered as possibly delaying the development of osteoporosis. The aim of this study was to determine the association between individual radiographic features of spine degeneration, bone mineral density (BMD) and bone-turn over markers.MethodsIt was a cross sectional study of 277 post menopausal women. BMD of all patients was assessed at the spine and hip using dual-energy X-ray absorptiometry. Lateral spinal radiographs were evaluated for features of disc degeneration. Each vertebral level from L1/2 to L4/5 was assessed for the presence and severity of osteophytes and disc space narrowing (DSN). For Bone turn-over markers, we assessed serum osteocalcin and C-terminal cross-linking telopeptide of type I collagen (CTX). Linear regressions and partial correlation were used respectively to determine the association between each of disc degeneration features, BMD, and both CTX and osteocalcin.ResultsMean age of patients was 58.7 ± 7.7 years. Eighty four patients (31.2%) were osteoporotic and 88.44% had spine osteoarthritis. At all measured sites, there was an increase in BMD with increasing severity of disc narrowing while there was no association between severity of osteophytes and BMD. After adjustment for age and BMI, there was a significant negative correlation between CTX and DSN. However, no significant correlation was found between CTX and osteophytes and between osteocalcin and both osteophytes or DSN.ConclusionIn post menopausal women the severity of disc narrowing, but not osteophytes, is associated with a generalized increase in BMD and a decreased rate of bone resorption. These results are consistent with the hypothesis that osteoarthritis, through DSN, has a protective effect against bone loss, mediated by a lower rate of bone resorption. However, spine BMD is not a relevant surrogate marker for the assessment of osteoporosis in the spine in patients with osteoarthritis and debate as to the relationship between OA and OP is still open because of the contradictory data in the literature.
Highlights
Several studies have observed an inverse relationship between osteoporosis and spinal osteoarthritis, the latter being considered as possibly delaying the development of osteoporosis
Mean age and body mass index (BMI) were 58.7 ± 7.7 years and 29.08 ± 4.35 kg/m2 respectively. 123 women (44.4%) had overweight (BMI > 25) and 101 (36.5%) were obese. 88.44% of the 277 included in the study had spine osteoarthritis and 31.2% were osteoporotic. 43.5% had osteopenia, 46.6% of them had at least a prevalent vertebral fracture and 12.3% had a history of low trauma peripheral fractures
No significant correlation was found between CTX and Maximum grade of radiographic feature (MAX) or SUM osteophytes and between osteocalcin; and both SUM and MAX disc space narrowing (DSN) or osteophytes
Summary
Several studies have observed an inverse relationship between osteoporosis and spinal osteoarthritis, the latter being considered as possibly delaying the development of osteoporosis. It would be anticipated that osteoporosis and osteoarthritis frequently coexist due to their high prevalence in elderly women but the association between these conditions is still controversial [1,2] even after years of research since the first results indicate an apparent inverse relationship [3,4]. There are conflicting findings in the few published studies on the association between bone mass and degenerative disease in the spine, the latter being characterized by disc space narrowing (DSN) and the presence of vertebral osteophytes. In a population of patients with OA of the hip, isolated DSN without osteophytes was not associated with high bone mass [17]. In a general population, those with isolated DSN have a higher BMD in the spine (but not in the hip) than those without [9]
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