The Association of Lumbar Disc Herniation with Lumbar Volumetric Bone Mineral Density in a Cross-Sectional Chinese Study

Causal relationship between intervertebral disc degeneration and osteoporosis: a bidirectional two-sample Mendelian randomization study

Introduction

The relationship between intervertebral disc degeneration (IVDD) and osteoporosis (OP), diagnosed primarily using bone mineral density (BMD), remains unclear so far. The present study, therefore, aimed to investigate the potential relationship between osteoporosis and intervertebral disc degeneration using Mendelian randomization and genome-wide association analyses. Specifically, the impact of bone mineral density on the development of intervertebral disc degeneration was evaluated.

Materials and methods

The genome-wide association studies (GWAS) summary data of OP/BMDs and IVDD were collected from the FinnGen consortium, the GEFOS consortium, and MRC-IEU. The relationship between IVDD and OP was then explored using TSMR. The inverse-variance weighted (IVW) method was adopted as the primary effect estimate, and the reliability and stability of the results were validated using various methods, including MR-Egger, weighted median, simple mode, weighted mode, and MR-PRESSO.

Results

No significant causal relationship was observed between OP and IVDD (IVW, P > 0.05) or between femoral neck BMD (FA-BMD) and IVDD when OP and FA-BMD were used as exposures. However, increased levels of total body BMD (TB-BMD) and lumbar spine BMD (LS-BMD) were revealed as significant risk factors for IVDD (TB-BMD: IVW, OR = 1.201, 95% CI: 1.123-1.284, P = 8.72 × 10-8; LS-BMD: IVW, OR = 1.179, 95% CI: 1.083-1.284, P = 1.43 × 10-4). Interestingly, both heel BMD (eBMD) and femur neck BMD (FN-BMD) exhibited potential causal relationships (eBMD: IVW, OR = 1.068, 95% CI: 1.008-1.131, P = 0.0248; FN-BMD, IVW, OR = 1.161, 95% CI: 1.041-1.295, P = 0.0074) with the risk of IVDD. The reverse MR analysis revealed no statistically causal impact of IVDD on OP and the level of BMD (P > 0.05).

Conclusion

OP and the level of FA-BMD were revealed to have no causal relationship with IVDD. The increased levels of TB-BMD and LS-BMD could promote the occurrence of IVDD. Both eBMD and FN-BMD have potential causal relationships with the risk of IVDD. No significant relationship exists between IVDD and the risk of OP. Further research is warranted to comprehensively comprehend the molecular mechanisms underlying the impact of OP and BMD on IVDD and vice versa.

Does vertebral osteoporosis delay or accelerate lumbar disc degeneration? A systematic review

The effect of vertebral osteoporosis on disc degeneration is still debated. The purpose of this study was to provide a systematic review of studies in this area to further reveal the relationship between the two. Relevant studies were searched in electronic databases, and studies were screened according to inclusion and exclusion criteria, and finally, basic information of the included studies was extracted and summarized. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 34 publications spanning 24 years were included in our study. There were 19 clinical studies, including 12 prospective studies and 7 retrospective studies. Of these, 7 considered vertebral osteoporosis to be positively correlated with disc degeneration, 8 considered them to be negatively correlated, and 4 considered them to be uncorrelated. Two cadaveric studies were included, one considered the two to be negatively correlated and one considered them not to be correlated. Seven animal studies were included, of which five considered a positive correlation between vertebral osteoporosis and disc degeneration and two considered a negative correlation between the two. There were also 6 studies that used anti-osteoporosis drugs for intervention, all of them were animal studies. Five of them concluded that vertebral osteoporosis was positively associated with disc degeneration, and the remaining one concluded that there was no correlation between the two. Our systematic review shows that the majority of studies currently consider an association between vertebral osteoporosis and disc degeneration, but there is still a huge disagreement whether this association is positive or negative. Differences in observation time and follow-up time may be one of the reasons for the disagreement. A large number of clinical and basic studies are still needed in the future to further explore the relationship between the two.

The Comparison between Herniated and Non-Herniated Disc Levels Regarding Intervertebral Disc Space Height and Disc Degeneration, A Magnetic Resonance Study

PURPOSE

The main purpose of this study was to evaluate the intervertebral disc height and intervertebral disc degeneration between the normal group and the group with disc herniation at the level of the L4-L5 intervertebral disc by MRI using the Pfirrmann grading system.

MATERIALS AND METHODS

385 patients were included in this study. MRI images were reevaluated and intervertebral disc heights were measured from the anterior, middle and posterior segments. Researchers divided disc pathologies into two groups. In the non-herniated group; normal or bulging ones; in the herniated group, they included those with protrusion or extrusion.

RESULTS

385 lumbar MRI examinations meeting the study criteria were included in study. There were 56.9% (219/385) females and 43.1% (166/385) males in the study. For the whole patients in the study group, the intervertebral disc height values at the L4-5 level were measured as 12.34 mm, 11.58 mm, and 7.60 mm in the anterior, middle, and posterior localizations, respectively.

CONCLUSIONS

At the L4-5 level, the height of the disc distances in the herniated group was lower than in the normal group. The Pfirrman score was found to be higher in the herniated group in terms of disc degeneration compared to the normal group.

The Relationship Between Bone Mineral Density and Lumbar Disc Herniation in Postmenopausal Women

INTRODUCTION

In previous studies, the relationship between BMD (bone mineral density) and LDH (lumbar disc herniation) has been investigated in young people, except for postmenopausal women. The aim of this study was to evaluate this association in postmenopausal women.

METHODS

A cross-sectional analysis of 545 consecutive postmenopausal women was performed at a single center. The study included patients aged 45 to 85 with low back pain. Age, weight, height, L1-L4 BMD, L1-L4 T-score, L1-L4 Z-score, femoral neck BMD, femoral neck T-score, and femoral neck Z-score of patients were collected. MRI scans were assessed for the diagnosis of LDH. To explore the impact of the number of herniated segments, patients with LDH were further divided into single-level and multi-level LDH groups.

RESULTS

Five hundred and thirteen postmenopausal women were included in the final analysis. The mean age of the patients was 61.3±8.6 years in the LDH group and 58.4±7.8 years in the non-LDH group (p=0.001). The LDH group had higher lumbar (p<0.001) and femoral neck (p<0.05) BMD, T, and Z-scores than the non-LDH group. In binary logistic regression analysis, age, lumbar, and femoral neck BMD were significantly associated with LDH (p<0.001, p=0.03, and p=0.040, respectively). Patients with multi-level herniation had significantly higher rates of obesity (BMI ≥30) compared to patients with single-level herniation (58.0% vs. 47.0%; p=0.031). However, in terms of obesity rates, the LDH group and the non-LDH group were statistically similar (53.9% vs. 54.2%; p=0.961). There was no association between the single and multi-level herniation groups in terms of L1-4 and femoral neck BMD (p=0.760 and 0.435, respectively).

CONCLUSION

Higher lumbar bone mineral density and higher femoral neck bone mineral densities were found to be associated with lumber disc herniation in postmenopausal women with low back pain. These results suggest that bone mineral density assessment may be useful in clinical practice to determine which patients are at higher risk of lumbar disc herniation.

The association of lumbar disc degeneration with lumbar vertebral trabecular volumetric bone mineral density in an urban population of young and middle-aged community-dwelling Chinese adults: a cross-sectional study

INTRODUCTION

Lumbar intervertebral disc degeneration (LDD) and osteoporosis (OP) are age-related conditions that induce low back pain and have an impact on quality of life. The relationship between LDD and changes in bone mineral density (BMD) is, however, contentious and ever-changing. The purpose of this study is to investigate the relationship between lumbar vertebral volumetric BMD (vBMD) and LDD in an urban population of young and middle-aged community-dwelling Chinese adults.

MATERIALS AND METHODS

719 participants were recruited from among the subjects enrolled in a 10-year longitudinal study of degeneration of the spine and knee being conducted at the Beijing Jishuitan Hospital. The severity of LDD was graded using the five-grade Pfirrmann classification, and lumbar vertebral vBMD was measured using quantitative computed tomography (QCT). The relationship between the grade of intervertebral disc degeneration and lumbar vertebral vBMD was analyzed, and multiple linear regression was performed to adjust for covariates.

RESULTS

The mean lumbar vBMD decreased as the grade of LDD increased (171.5 g/cm3, 147.8 g/cm3, and 124.3 g/cm3, respectively; P < 0.001). After adjusting for age, a higher LDD stage was associated with a lower mean L2-L4 vBMD, although a statistically significant correlation was observed only in men (standardized coefficient β = - 0.656, P = 0.004). In men, there was a negative correlation between single-vertebra vBMD and degeneration of adjacent intervertebral discs, particularly those involving the L3 vertebra (L2-3 disc: β = - 0.333, P < 0.001, L3-4 disc: β = - 0.398, P < 0.001), as well as the mean grade of the L2-4 discs (β = - 0.448, P < 0.001). However, the L5-S1 disc had a smaller correlation with age than others, and no statistically significant associations with lumbar vBMD were observed in either men (β = - 0.024, P = 0.729) or women (β = - 0.057, P = 0.396).

CONCLUSION

Our study found that the degree of LDD was negatively associated with lumbar trabecular vBMD, although (excepting the L5-S1 disc), the relationship was statistically significant only in men.

The lumbar spinal endplate lesions grades and association with lumbar disc disorders, and lumbar bone mineral density in a middle-young general Chinese population

BACKGROUND

Lumbar vertebral endplates lesions (LEPLs), one of the etiologies of low back pain (LBP), are one of the most prevalent causes of health-care costs. Despite progressively becoming the focus in recent years, almost all studies have concentrated on symptomatic patients rather than general populations. As a result, our study was designed to determine the prevalence and distribution patterns of LEPLs in a middle-young general population, as well as their associations with lumbar disc herniation (LDH), lumbar disc degeneration (LDD), and lumbar vertebral volumetric bone mineral density (vBMD).

METHODS

Seven hundred fifty-four participants aged 20-60 years were recruited from the subjects enrolled in a 10-year longitudinal study of degeneration of the spine and knee being conducted at the Beijing Jishuitan Hospital and 4 of them were excluded due to the missing of MRIs. In this observational study, a lumbar quantitative computed tomography (QCT) and MRI scan were performed among participants within 48 h. T2-weighted sagittal lumbar MRI images for all included subjects were identified for LEPLs by two independent observers based on morphological and local characteristics. Lumbar vertebral vBMD was measured with QCT. The age, BMI, waistline, hipline, lumbar vBMD, LDD, and LDH were measured to investigate their associations with LEPLs.

RESULTS

The prevalence of LEPLs was higher among the male subjects. 80% of endplates were recognition as no lesions with a substantial disparity between female (75.6%) and male subjects (83.4%) (p < 0.001). The most common lesions were "wavy/irregular" and "notched", and "fracture" is most involved in L3-4 inferior endplate both in two genders. LEPLs were found to be associated with LDH (≥ 2 levels: OR = 6.859, P < 0.001; 1 level: OR = 2.328, P = 0.002 in men. OR = 5.004, P < 0.001; OR = 1.805, P = 0.014 in women) reference for non-LDH, and hipline in men (OR = 1.123, P < 0.001).

CONCLUSIONS

LEPLs are the common findings on lumbar MRIs in general population, particularly in men. The presence of these lesions and advance from slightly to severely could be mainly attributed to LDH and men's higher hipline.

The prevalence of Schmorl's nodes in osteoporotic vs normal patients: a Middle Eastern population study

The study was conducted to establish the association of Schmorl's nodes and osteoporosis in a Middle Eastern cohort. The prevalence of SN in this sample was 41.1%. It was most frequent in the lumbar spine typically solitary central lesions. Over 88% Schmorl's node cases were osteoporotic/osteopenic and only 11.6% normal.

INTRODUCTION

This study aims to identify the prevalence of Schmorl's nodes (SNs) in a cohort of Omani nationals, and also to determine any relation between osteoporosis and Schmorl's nodes.

METHODS

This retrospective observational study was conducted on Omani nationals. One thousand three hundred and forty-eight DEXA scan patients were included. Of these, 545 patients had complete X-rays and MRI scans that would help determine the SN status. The X-rays and sagittal, coronal, and axial T2-weighted MR images were used to identify the presence and exact location of the Schmorl nodes by one orthopedic trainee and confirmed by the senior author. The correlation of each parameter with the presence of SN was analyzed by the independent-samples T test and one-way ANOVA.

RESULTS

The overall prevalence of SN in this population sample appeared to be 41.1%. Over 88% of the SN-positive cases were either osteopenic or frankly osteoporotic by the WHO definition. Vast majority of SNs (87.1%) occurred in the lumbar spine and were central in location and mostly solitary. Statistical analysis of the data revealed significant correlation between osteopenia or osteoporosis and the presence of SNs.

CONCLUSIONS

The prevalence of SN in the sample of Omanis studied was 41.1% and was most frequently seen in older men in the lumbar spine. It is strongly associated with osteoporosis/osteopenia (88.4%) and frequently presents as solitary central lesions.

Correlation Analysis between Tamoxifen and Lumbar Intervertebral Disc Degeneration: A Retrospective Case-Control Study

Objectives

To investigate the correlation between tamoxifen (TAM) and lumbar intervertebral disc (IVD) degeneration (IVDD).

Methods

The patients who visited the department of spine surgery from January 2015 to December 2020 were retrospectively reviewed. Those with a history of breast cancer surgery were identified and their data were collected. These data included patients' age, body mass index (BMI), menstrual history, postoperative history, drug treatment plan, and imaging data. The participants were divided into the TAM group and the non-TAM group. Lumbar IVDD was assessed by lumbar lordosis (LL), vertebral CT density, lumbar disc height index (DHI), Modic changes, and modified Pfirrmann grading score. SPSS 20 was used for statistical analysis.

Results

A total of 75 patients were included in this study, 46 patients in the TAM group and 29 patients in the non-TAM group. No significant differences were present in age, BMI, postoperative history, LL, and vertebral CT density between the two groups. The DHI of L1/2 and L2/3 in the TAM group was lower compared to the non-TAM group (P=0.038 and P=0.034, respectively), while comparisons regarding the DHI of L3/4, L4/5, and L5/S1, and the average DHI between TAM and non-TAM groups were not significant. The modified Pfirrmann grading scores of the L1/2 and L2/3 IVDs in the TAM group were higher than those in the non-TAM group (P=0.004 and P=0.025, respectively). Comparisons of L3/4, L4/5, and L5/S1 between the two groups were not significant. The comparisons regarding the occurrence of Modic changes did not show a significant difference between the TAM and non-TAM groups.

Conclusions

This study indicates that there might be some positive correlation between TAM use and lumbar IVDD. In particular, the degeneration of L1/2 and L2/3 has shown a correlation with TAM use.

Q-Dixon and GRAPPATINI T2 Mapping Parameters: A Whole Spinal Assessment of the Relationship Between Osteoporosis and Intervertebral Disc Degeneration

BACKGROUND

The relationship between osteoporosis and intervertebral disc (IVD) degeneration remains controversial. Novel quantitative Dixon (Q-Dixon) and GRAPPATINI T2 mapping techniques have shown potential for evaluating the biochemical components of the spine.

PURPOSE

To investigate the correlation of osteoporosis with IVD degeneration in postmenopausal women.

STUDY TYPE

Prospective.

SUBJECTS

A total of 105 postmenopausal females (mean age, 65 years; mean body mass index, 26 kg/m² ).

FIELD STRENGTH/SEQUENCE

3 T; sagittal; 6-echo Q-Dixon, multiecho spin-echo GRAPPATINI T2 mapping, turbo spin echo (TSE) T1-weighted and TSE T2-weighted sequences.

ASSESSMENT

The subjects were divided into normal (N = 47), osteopenia (N = 28), and osteoporosis (N = 30) groups according to quantitative computed tomography examination. The Pfirrmann grade of each IVD was obtained. Region of interest analysis was performed separately by two radiologists (X.L., with 10 years of experience, and S.C., with 20 years of experience) on a fat fraction map and T2 map to calculate the bone marrow fat fraction (BMFF) from the L1 to L5 vertebrae and the T2 values of each adjacent IVD separately.

STATISTICAL TESTS

One-way analysis of variance, post-hoc comparisons, and Kruskal-Wallis H tests were performed to evaluate the differences in the magnetic resonance imaging parameters between the groups. The relationships between BMFF and the IVD features were analyzed using the Spearman correlation analysis and linear regression models.

RESULTS

There were significant differences in BMFF among the three groups. The osteoporosis group had higher BMFF values (64.5 ± 5.9%). No significant correlation was found between BMFF and Pfirrmann grade (r = 0.251, P = 0.06). BMFF was significantly negatively correlated with the T2 of the adjacent IVD from L1 to L3 (r = -0.731; r = -0.637; r = -0.547), while significant weak correlations were found at the L4 to L5 levels (r = -0.337; r = -0.278).

DATA CONCLUSION

This study demonstrated that osteoporosis is associated with IVD degeneration.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY: Stage 4.