Association of lumbar disc degeneration with osteoporotic fractures; the Rotterdam study and meta-analysis from systematic review

M C Castaño-Betancourt; L Oei; F Rivadeneira; E I T de Schepper; A Hofman; S Bierma-Zeinstra; H A P Pols; A G Uitterlinden; J B J Van Meurs

doi:10.1016/j.bone.2013.08.004

Association of lumbar disc degeneration with osteoporotic fractures; the Rotterdam study and meta-analysis from systematic review

Bone. 2013 Nov;57(1):284-9. doi: 10.1016/j.bone.2013.08.004. Epub 2013 Aug 17.

Authors

M C Castaño-Betancourt¹, L Oei, F Rivadeneira, E I T de Schepper, A Hofman, S Bierma-Zeinstra, H A P Pols, A G Uitterlinden, J B J Van Meurs

Affiliation

¹ Department of Internal Medicine, Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands; The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), 2300 RC Leiden, The Netherlands; Department of Epidemiology, Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands.

PMID: 23958823
DOI: 10.1016/j.bone.2013.08.004

Abstract

Objective: To investigate the relation between lumbar disc degeneration (LDD) and all type of osteoporotic (OP) fractures including vertebral.

Methods: This study is part of the Rotterdam study, a large prospective population-based cohort study among men and women aged 55years and over. In 2819 participants spine radiographs were scored for LDD (osteophytes and disc space narrowing (DSN)) from L1 till S1, using the Lane atlas. Osteoporotic (OP) fracture data were collected and verified by specialists during 12.8years. We considered two types of vertebral fractures (VFx): Clinical VFx (symptomatic fractures recorded by medical practitioners) and Radiographic VFx (using the McCloskey-Kanis method). Meta-analysis of published studies reporting an association of LDD features and VFx was performed. Differences in Bone Mineral Density (BMD) between participants with and without LDD features were analyzed using ANOVA. Risk of OP-fractures was analyzed using Cox regression.

Results: In a total of 2385 participants, during 12.8years follow-up, 558 suffered an OP-fracture. Subjects with LDD had an increased OP fracture risk compared to subjects without LDD (HR: 1.29, CI: 1.04-1.60). LDD-cases have between 0.3 and 0.72 standard deviations more BMD than non-cases in all analyzed regions including total body BMD and skull BMD (P<0.001). Only males with LDD had increased risk for OP-fractures compared to males without LDD (adjusted-HR: 1.80, 95%CI: 1.20-2.70, P=0.005). The risk was also higher for VFx in males (HR: 1.64, CI: 1.03-2.60, P: 0.04). The association LDD-OP-fractures in females was lower and not significant (adjusted-HR: 1.08, 95%CI: 0.82-1.41). Meta-analyses showed that the risk of VFx in subjects with LDD has been studied only in women and there is not enough evidence to confidently analyze the relationship between LDD-features (DSN or/and OPH) and VFx due to low power and heterogeneity in phenotype definition in the collected studies.

Conclusions: Male subjects with LDD have a higher osteoporotic fracture risk, in spite of systemically higher BMD.

Keywords: BMD; BMI; Body Mass Index; Bone Mineral Density; DSN; Disc space narrowing; LDD; Lumbar disc degeneration; OA; OP; OPH; Osteoporotic fractures; VFx; Vertebral fractures; disc space narrowing; lumbar disc degeneration; osteoarthritis; osteophytes; osteoporotic; vertebral fractures.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Bone Density / physiology
Female
Humans
Intervertebral Disc Degeneration / epidemiology*
Intervertebral Disc Degeneration / metabolism
Intervertebral Disc Displacement / epidemiology*
Intervertebral Disc Displacement / metabolism
Male
Osteoporotic Fractures / epidemiology*
Osteoporotic Fractures / metabolism
Risk Factors

Supplementary concepts

Intervertebral disc disease