The association of spinal osteoarthritis with lumbar lordosis.

BACKGROUND: Careful review of published evidence has led to the postulate that the degree of lumbar lordosis may possibly influence the development and progression of spinal osteoarthritis, just as misalignment does in other joints. Spinal degeneration can ensue from the asymmetrical distribution of loads. The resultant lesions lead to a domino- like breakdown of the normal morphology, degenerative instability and deviation from the correct configuration. The aim of this study is to investigate whether a relationship exists between the sagittal alignment of the lumbar spine, as it is expressed by lordosis, and the presence of radiographic osteoarthritis. METHODS: 112 female subjects, aged 40-72 years, were examined in the Outpatients Department of the Orthopedics' Clinic, University Hospital of Heraklion, Crete. Lumbar radiographs were examined on two separate occasions, independently, by two of the authors for the presence of osteoarthritis. Lordosis was measured from the top of L1 to the bottom of L5 as well as from the top of L1 to the top of S1. Furthermore, the angle between the bottom of L5 to the top of S1 was also measured. RESULTS AND DISCUSSION: 49 women were diagnosed with radiographic osteoarthritis of the lumbar spine, while 63 women had no evidence of osteoarthritis and served as controls. The two groups were matched for age and body build, as it is expressed by BMI. No statistically significant differences were found in the lordotic angles between the two groups CONCLUSIONS: There is no difference in lordosis between those affected with lumbar spine osteoarthritis and those who are disease free. It appears that osteoarthritis is not associated with the degree of lumbar lordosis.

Lumbar lordosis in osteoporosis and in osteoarthritis.

The curvature of the lumbar spine and the risk of developing either osteoporosis (OP) or osteoarthritis (OA) are influenced by many common factors. The aim of this study is to determine whether lumbar lordosis is different between patients with either disease and healthy persons. A cross-sectional, blinded, controlled design was implemented. One hundred and twelve postmenopausal women were evaluated for bone mineral density as well as undergoing spinal radiography. Lordosis measurement was performed with Cobb's method. The sample was divided in four groups: patients with OP (n = 34, L1-L5 = 40.7 degrees, L1-S1 = 54.1 degrees), patients with OA (n = 29, L1-L5 = 38 degrees, L1-S1 = 52.3 degrees), patients with both diseases (n = 20, L1-L5 = 41.8 degrees, L1-S1 = 52.3 degrees) and controls (n = 29, L1-L5 = 38.6 degrees, L1-S1 = 51.8 degrees). For all participants age, height, weight, body mass index, physical activity level and basal metabolic rate were measured and recorded. The results revealed that although the four groups have significant constitutional differences, lumbar lordosis was comparable between them. The reasons for the lack of association are discussed.

Does raloxifene treatment influence back pain and disability among postmenopausal women with osteoporosis?

Clinical studies have suggested that postmenopausal women on estrogen replacement treatment are more likely to experience back pain and related disability compared to women who do not take estrogens. Raloxifene, a selective estrogen receptor modulator has estrogen-like effects on bone tissue, and antagonize the action of estrogens on endometrium and breast tissue. It is unknown if the treatment of osteoporosis with raloxifene has estrogen-like or opposite effects on back pain and functional capacity among postmenopausal women with osteoporosis. A total of 120 postmenopausal women with osteoporosis and chronic back pain were randomized to receive raloxifene 60 mg with 1,000 mg calcium, and 800 IU vitamin D daily or 1,000 mg calcium and 800 IU vitamin D daily. Pain intensity and pain-related disability were measured before treatment at 6 months and after 1 year. Repeated measures of ANOVA, did not reveal statistically significant differences over time, on pain intensity and disability scores, between groups studied. There was a trend in pain intensity changes during the follow-up period, but the differences between the groups were not statistically significant. It seems that treatment with raloxifene does not influence back pain and disability among postmenopausal women with osteoporosis. Raloxifene may have estrogenic agonist effects on nociceptive processing in the central nervous system.

Assessment of the skeletal status by MR relaxometry techniques of the lumbar spine: comparison with dual X-ray absorptiometry.

PURPOSE: To measure lumbar spine T2*, T2, T2' and T1 MR relaxometry parameters and compare them with lumbar spine bone mineral density (BMD) in a group of postmenopausal women. MATERIALS AND METHODS: Lumbar spine T2*, T2, T2' and T1 MR relaxometry parameters and BMD values were assessed in 101 postmenopausal women (mean age: 61.8 +/- 7.1 (1 S.D.) years); of them 63 referred to as control subjects (group A, BMD T-scores > or = -2.5 S.D.) and 38 as osteoporotic (group B, BMD T-scores < -2.5 S.D.). All magnetic resonance imaging (MRI) examinations were performed on an 1.5 T imaging system using: (a) a 2D single slice multi echo (32 echoes) gradient echo (MEGRE) sequence (TR/TE1/TE32/FA: 160/2.7/74.93 ms/25 degrees for the T2* measurement, (b) a respiratory gated 2D single slice Multi Echo (16 echoes) Spin Echo (MESE) sequence (TR/TE1/TE16/FA: 2000-2500/22.5/360 ms/90 degrees) for the T2 measurement and (c) a 2D single slice multi TI (18 repeats) turbo Fast Low Angle Shot (turbo FLASH) sequence (TR/TE/TI1/TI16/FA: 11/4.2/10/5000 ms/10 degrees) for the T1 measurement. T2' was calculated from its definition equation: (1/T2' = 1/T2* - 1/T2). Lumbar spine BMD was assessed using DXA. RESULTS: All measured parameters showed statistically significant differences between groups A and B (from P < 0.05 to <0.001). All parameters showed significant associations with subject's age ranging from r = 0.245 (P < 0.05) for the T2 up to r = 0.377 (P < 0.001) for the T2*. All parameters showed significant associations with subject's BMD measurements ranging from r = -0.184 (P < 0.05) for the R1 = (1/T1) up to r = -0.345 (P < 0.0005) for the T2. CONCLUSION: Among the MR relaxometry parameters studied, T2* and T2 showed better discrimination of patients with osteoporosis from control subjects.