Radiographic Lumbar Spondylosis Is Highly Prevalent in Elderly Patients
Radiographic lumbar spondylosis is highly prevalent in the elderly and disc space narrowing may be a risk factor for low back pain, according to the results of a Japanese population-based cohort study reported in the August 21 Online First issue of the Annals of the Rheumatic Diseases.
“Although lumbar spondylosis is a major cause of low back pain and disability in the elderly, few epidemiologic studies have been performed,” write Shigeyuki Muraki, from the University of Tokyo in Japan, and colleagues from the Research on Osteoarthritis Against Disability (ROAD) study. “We investigated the prevalence of radiographic lumbar spondylosis using a large-scale population, and examined the association with low back pain.”
The investigators analyzed data from 2288 participants (818 men and 1470 women) enrolled in the nationwide ROAD cohort study. Participants were at least 60 years of age and lived in urban, mountainous, or seacoast communities. Kellgren/Lawrence (KL) grading was used to characterize radiographic severity at lumbar intervertebral levels from L1/2 to L5/S.
In the study sample, prevalence of radiographic spondylosis with KL ? 2 and KL ? 3 at the most severely affected intervertebral level was 75.8% and 50.4%, respectively. Prevalence of low back pain was 28.8%. KL ? 2 spondylosis was more prevalent in men. Risk factors for both KL ? 2 and KL ? 3 spondylosis were age and body mass index (BMI).
Compared with KL = 0 or KL = 1, KL = 2 spondylosis was not significantly associated with low back pain. However, KL ? 3 spondylosis was significantly associated with low back pain only in women.
“The present cross-sectional study using a large population revealed a high prevalence of radiographic lumbar spondylosis in the elderly,” the study authors write. “Gender seems to be distinctly associated with KL ? 2 and KL ? 3 lumbar spondylosis, and disc space narrowing with or without osteophytosis in women may be a risk factor for low back pain.”
Limitations of this study include cross-sectional analysis; participants lived independently, potentially underestimating calculated prevalence; definition of low back pain used in this study did not determine the severity; analyses did not include facet joint osteoarthritis nor vertebral fracture, which would likely be associated with low back pain; and lack of clarity in KL grading for how to characterize lumbar spondylosis with disc space narrowing but no osteophytosis.
“Further progress, along with continued longitudinal survey in the ROAD study, will elucidate the environmental and genetic backgrounds of lumbar spondylosis and its relation with low back pain,” the study authors conclude.
The Japanese Ministry of Education, Culture, Sports, Science and Technology; the Ministry of Health, Labor and Welfare; and the Japanese Orthopaedic Association supported this study.
Clinical Context
In most developed countries, lumbar spondylosis is associated with morbidity and chronic disability in the elderly. However, there are limited data regarding the prevalence of lumbar spondylosis and its association with symptoms.
Lumbar spondylosis is characterized by disc degeneration and osteophytosis, with the most popular grading system for the radiographic severity of osteoarthritis being the KL system with classification into 5 grade (0-4) scales. The main clinical symptom of lumbar spondylosis is thought to be low back pain, but its association with radiographic severity is still unclear.
Study Highlights
* The ROAD study is a nationwide prospective cohort study for bone and joint diseases, consisting of population-based cohorts established in several communities in Japan beginning in 2005.
* The objective of ROAD is to establish epidemiologic indexes to evaluate clinical evidence for the development of disease-modifying treatment.
* The baseline database of ROAD thus far contains detailed clinical and genetic information on 3 population-based cohorts in urban, mountainous, and seacoast communities of Japan.
* The KL system used in this study for classification of radiographic lumbar spondylosis has 5 grade (0-4) scales, with KL ? 2 being the conventional standard for diagnosis.
* KL grade 2 is defined as osteophyte formation and grade 3 as disc space narrowing plus osteophyte formation.
* Of 2288 participants providing data for this cross-sectional analysis, 818 were men and 1470 were women.
* Participants were at least 60 years of age and lived independently in urban, mountainous, or seacoast communities.
* At lumbar intervertebral levels from L1/2 to L5/S, KL grading was used to characterize radiographic severity.
* Prevalence of radiographic spondylosis with KL ? 2 and KL ? 3 at the most severely affected intervertebral level was 75.8% and 50.4%, respectively.
* KL ? 2 spondylosis was more prevalent in men (84.1%) than in women (70.7%).
* However, KL ? 3 spondylosis was more prevalent in women.
* Overall prevalence of low back pain was 28.8%.
* Risk factors for both KL ? 2 and KL ? 3 spondylosis were age and BMI.
* KL ? 2 and KL ? 3 spondylosis tended to increase with age, and there was a significant difference in prevalence between those in their 60s and 70s, but not thereafter.
* The difference in prevalence of spondylosis between communities was significant even after adjustment for age and BMI, indicating the involvement of genetic or other factors.
* Compared with KL = 0 or KL = 1, KL = 2 spondylosis was not significantly associated with low back pain.
* KL ? 3 spondylosis was significantly associated with low back pain only in women.
* Odds ratio of KL ? 3 spondylosis for low back pain was 1.44 in men and 1.80 in women.
* The investigators concluded that there was a high prevalence of radiographic lumbar spondylosis in the elderly, that sex was associated with KL ? 2 and KL ? 3 lumbar spondylosis, and that disc space narrowing with or without osteophytosis in women may be a risk factor for low back pain.
Pearls for Practice
* Radiographic lumbar spondylosis is common in the elderly. KL ? 2 spondylosis was more prevalent in men (84.1%) than in women (70.7%), but KL ? 3 spondylosis was more prevalent in women.
* Risk factors for both KL ? 2 and KL ? 3 spondylosis were increasing age and BMI.
Popularity: 70% [?]