Osteoporosis, spinal degenerative disorders, and their association with low back pain, activities of daily living, and physical performance in a general population

Abstract

Osteoporosis, vertebral fractures, and spinal degenerative diseases are common conditions that often coexist in older adults. This study aimed to determine the factors influencing low back pain and its impact on activities of daily living (ADL) and physical performance in older individuals with multiple comorbidities. This cross-sectional study was part of a large-scale population-based cohort study in Japan, involving 1009 participants who underwent spinal magnetic resonance imaging (MRI) to assess cervical cord compression, radiographic lumbar spinal stenosis, and lumbar disc degeneration. Vertebral fractures in the thoracolumbar spine were evaluated using sagittal MRI with a semi-quantitative method. Bone mineral density was measured using dual-energy X-ray absorptiometry. Low back pain, Oswestry Disability Index (ODI), and physical performance tests, such as one-leg standing time, five times chair-stand time, maximum walking speed, and maximum step length, were assessed. Using clinical conditions as objective variables and image evaluation parameters as explanatory variables, multiple regression analysis showed that vertebral fractures were significantly associated with low back pain and ODI. Vertebral fractures and osteoporosis significantly impacted physical performance, whereas osteoporosis alone did not affect low back pain or ODI. Our findings contribute to new insights into low back pain and its impact on ADL and physical performance.

Keywords: Aging; Low back pain; Musculoskeletal disorders; Osteoporosis; Physical performance; Vertebral fractures.

Figure 1

Flow diagram of participant recruitment for the Wakayama Spine Study from the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study.

Figure 2

Measurement figures of cervical cord compression. Cervical cord compression was defined as grade 2 or higher at the most severely affected intervertebral disc level.

Figure 3

Measurement figures of rLSS (radiographic lumbar spinal stenosis). rLSS was defined as grade 3 at the most severely affected lumbar intervertebral disc level.

Figure 4

(a) Example figure of LDD (lumbar disc degeneration); (b) Example figure of vertebral fracture in the thoracolumbar spine.