Degenerative changes at the lumbar spine—implications for bone mineral density measurement in elderly women

Variation in the PTH2R gene is associated with age-related degenerative changes in the lumbar spine

“…women between the ages of 70--79 and over 60% of those over 80 [20]. Furthermore, degenerative manifestations in the lumbar spine becomes increasingly common with advancing age and we have recently reported a gradient of vertebra being affected by these changes (L1 least and L4 most affected), with up to 36% of all L4 vertebrae having degenerative manifestations in elderly women [6]. Vertebral degenerative manifestations are a phenotype not commonly investigated in genetic studies of osteoporosis, yet in addition to the diagnostic implications of falsely elevated BMD readings [3,21], there is also the possibility that in genetic studies using elderly cohorts, potential associations with BMD may be masked.…”

“…Minor allele frequencies (MAF) were similar to those reported in HapMap (www.hapmap.org). The basic clinical characteristics of the OPRA study participants including bone density have been reported in detail [13,18], as has the prevalence of apparent degenerative changes, scoliosis and vertebral fractures from visual assessment of the DXA scans [6]. Characteristics of the women attending at baseline and at 5 year and 10 year follow--up visits are shown in Table 2.…”

“…In addition, scoliosis was graded: grade 0,-- none; grade 1, yes (i.e. Cobb angel L1--L4 >10 degree) and fracture: grade 0 -- none; grade 1 -- suspected; grade 2 - yes [6]. The sensitivity of detecting X--ray verified degenerative changes on the DXA image was moderately high in L2--L4 (70--82%) but lower in L1 (42%) as previously reported [6].…”

“…Due to technical reasons or surgery, the number of assessable DXA scans varied slightly at each time point (baseline n=973--976; 5y n=691--698; 10y n=377--380) [6].…”

“…To assess the influence of apparent degenerative spine changes on clinical DXA assessment over time, in a previous study, we evaluated degenerative manifestations in each individual lumbar vertebra over a 10 year period. These changes accelerated over time, were most pronounced in the distal segments and had significant impact on diagnosing osteoporosis in elderly women [6].…”