title: Association of lumbar disc degeneration with osteoporotic fractures; the Rotterdam study and meta-analysis from systematic review.
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.
authors: 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.
authors: M C
authors: MC
authors: Castaño-Betancourt
authors: L
authors: L
authors: Oei
authors: F
authors: F
authors: Rivadeneira
authors: E I T
authors: EI
authors: de Schepper
authors: A
authors: A
authors: Hofman
authors: S
authors: S
authors: Bierma-Zeinstra
authors: H A P
authors: HA
authors: Pols
authors: A G
authors: AG
authors: Uitterlinden
authors: J B J
authors: JB
authors: Van Meurs
mesh_terms: D015519:Bone Density / Q000502:physiology; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology* / Q000378:metabolism; D007405:Intervertebral Disc Displacement / Q000453:epidemiology* / Q000378:metabolism; D008297:Male; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000378:metabolism; D012307:Risk Factors
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