Top

Osteoporosis International

Published in:

01-02-2009 | Review

Bone health and back pain: What do we know and where should we go?

Authors: A. M. Briggs, L. M. Straker, J. D. Wark

Published in: Osteoporosis International | Issue 2/2009

Abstract

Summary

Bone health is generally not considered in patients who present with chronic back pain. Nonetheless, bone health and back pain share common genetic and environmental correlates suggesting a co-dependence. Evidence exists for a relationship between back pain and impaired bone health. Here we present the evidence, theoretic framework and clinical relevance.

Bone health and back pain are important determinants of musculoskeletal health. Back pain experienced in youth is a risk factor for future back pain, while suboptimal bone health during development increases the risk of skeletal fragility in later life. Generally, bone health is not considered in patients with chronic back pain who do not demonstrate other well-recognised bone health risk factors or associated conditions. Nonetheless, evidence suggests that back pain and impaired bone health share common environmental and genetic correlates, indicating that bone health ought to be considered in the context of back pain in otherwise healthy individuals. This review describes the likely mechanisms explaining the relationship between back pain and impaired bone health, evidence concerning the relationship and suggestions for future research. A narrative literature search was conducted using CINAHL, Medline, PubMed and Web of Science electronic databases. A history of back pain is associated with decreased bone mineral density in adults, yet this tends to be site-specific. No studies were identified examining this association in youth, yet the negative effects of childhood skeletal trauma and obesity on bone and spinal health provide indirect evidence for an association. Further research is required to clarify the impact of back pain on bone health at different lifespan stages using prospective cohort designs.

Kleerekoper M, Nelson DA (1997) Which bone density measurement? J Bone Miner Res 12:712–14PubMed

NIH Consensus Development Panel (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–95

Bakker I, Twisk JW, Van Mechelen W et al (2003) Ten-year longitudinal relationship between physical activity and lumbar bone mass in (young) adults. J Bone Miner Res 18:325–32PubMed

Anderson JJB, Rondano PA (1996) Peak bone mass development of females: Can young adult women improve their peak bone mass? J Amer Coll Nutrit 15:570–74

Delvaux K, Lefevre J, Philippaerts R et al (2001) Bone mass and lifetime physical activity in Flemish males: a 27-year follow-up study. Med Sci Sport Exer 33:1868–75

Kemper HCG, Twisk JWR, van Mechelen W et al (2000) A fifteen-year longitudinal study in young adults on the relation of physical activity and fitness with the development of the bone mass: The Amsterdam Growth and Health Longitudinal Study. Bone 27:847–53PubMed

Bouxsein ML, Uchiyama T, Rosen CJ et al (2004) Mapping quantitative trait loci for vertebral trabecular bone volume fraction and microarchitecture in mice. J Bone Miner Res 19:587–99PubMed

Lei SF, Jiang H, Deng FY et al (2007) Searching for genes underlying susceptibility to osteoporotic fracture: current progress and future prospect. Osteoporos Int 18:1157–75PubMed

Australian Institute of Health & Welfare. Australia’s Health (2006) The tenth biennial health report of the Australian Institute of Health and Welfare. Canberra, AIHW

10.

Seeman E, Eisman JA (2004) MJA Practice Essentials. 7: Endocrinology—treatment of osteoporosis: why, whom, when and how to treat. Med J Aust 180:298–303PubMed

11.

Engelke K, Kemmler W, Lauber D et al (2006) Exercise maintains bone density at spine and hip EFOPS: a 3-year longitudinal study in early postmenopausal women. Osteoporos Int 17:133–42PubMed

12.

Berard A, Bravo G, Gauthier P (1997) Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporos Int 7:331–37PubMed

13.

Wong PKK, Christie JJ, Wark JD (2007) The effects of smoking on bone health. Clin Sci 113:233–41PubMed

14.

Lippuner K, Haller B, Casez JP et al (1996) Effect of disodium monofluorophosphate, calcium and vitamin D supplementation on bone mineral density in patients chronically treated with glucocorticosteroids: a prospective, randomized, double-blind study. Miner Electrol Metabol 22:207–13

15.

Rapuri PB, Gallagher JC, Haynatzka V (2003) Protein intake: effects on bone mineral density and the rate of bone loss in elderly women. Amer J Clin Nutrit 77:1517–25

16.

Bachrach LK (2001) Acquisition of optimal bane mass in childhood and adolescence. Trends Endocrinol Metabol 12:22–28

17.

Walker BF, Muller R, Grant WD (2003) Low back pain in Australian adults: the economic burden. Asia Pacific J Pub Health 15:79–87

18.

Walker BF, Muller R, Grant WD (2004) Low back pain in Australian adults. Prevalence and associated disability. J Manip Physiol Therap 27:238–44

19.

Cassidy JD, Carroll LJ, Cote P (1998) The Saskatchewan Health and Back Pain Survey: the prevalence of low back pain and related disability in Saskatchewan adults. Spine 23:1860–7PubMed

20.

Schmidt CO, Raspe H, Pfingsten M et al (2007) Back pain in the German adult population—prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine 32:2005–11PubMed

21.

Wedderkopp N, Leboeuf-Yde C, Andersen LB et al (2001) Back pain reporting pattern in a Danish population-based sample of children and adolescents. Spine 26:1879–83PubMed

22.

Leboeuf-Yde C, Kyvik KO (1998) At what age does low back pain become a common problem? A study of 29,424 individuals aged 12–41 years. Spine 23:228–34PubMed

23.

Taimela S, Kujala UM, Salminen JJ et al (1997) The prevalence of low back pain among children and adolescents—a nationwide, cohort-based questionnaire survey in Finland. Spine 22:1132–36PubMed

24.

McMeeken J, Tully E, Stillman B et al (2001) The experience of back pain in young Australians. Man Ther 6:213–20PubMed

25.

O'Sullivan PB, Straker L, Smith AL et al (2008) Carer experience of back pain is associated with adolescent back pain experience when controlling for other carer and family factors. Clin J Pain 24:226–31PubMed

26.

Jeffries LJ, Milanese SF, Grimmer-Somers KA (2007) Epidemiology of adolescent spinal pain. A systematic overview of the research literature. Spine 32:2630–37PubMed

27.

Watson KD, Papageorgiou AC, Jones GT et al (2002) Low back pain in schoolchildren: occurrence and characteristics. Pain 97:87–92PubMed

28.

Hakala P, Rimpela A, Salminen JJ et al (2002) Back, neck and shoulder pain in Finnish adolescents: National cross sectional surveys. BMJl 325:743–45

29.

Bailey DA, McKay HA, Mirwald RL et al (1999) A six-year longitudinal study of the relationship of physical activity to bone mineral accrual in growing children: The University of Saskatchewan bone mineral accrual study. J Bone Miner Res 14:1672–79PubMed

30.

Bailey DA, Martin AD, McKay HA et al (2000) Calcium accretion in girls and boys during puberty: A longitudinal analysis. J Bone Miner Res 15:2245–50PubMed

31.

Young D, Hopper JL, Nowson CA et al (1995) Determinants of bone mass in 10- to 26-year old females: a twin study. J Bone Miner Res 10:558–67PubMedCrossRef

32.

Sjolie AN (2004) Persistence in changes in nonspecific low back pain among adolescents. A 3-year prospective study. Spine 29:2452–57PubMed

33.

Hestbaek L, leboeuf-Yde C, Kyvik KO et al (2006) The course of low back pain from adolescence to adulthood. Eight year follow-up of 9600 twins. Spine 31:468–72PubMed

34.

Brattberg G (2004) Do pain problems in young school children persist into early adulthood? A 13-year follow-up. Eur J Pain 8:187–99PubMed

35.

Jones GT, Macfarlane GJ (2005) Epidemiology of low back pain in children and adolescents. Arch Dis Childhood 90:312–16

36.

Briggs AM, Greig AM, Wark JD (2007) The vertebral fracture cascade in osteoporosis. A review of aetiopathogenesis. Osteoporos Int 18:575–84PubMed

37.

Kado DM, Prenovost K, Crandall C (2007) Narrative review: hyperkyphosis in older persons. Ann Int Med 147:330–38PubMed

38.

Jones G, Nguyen T, Sambrook PN et al (1995) A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly. J Rheumatol 22:932–36PubMed

39.

Folman Y, Shabat S, Gepstein R (2004) Relationship between low back pain in post-menopausal women and mineral content of lumbar vertebrae. Arch Gerontol Geriat 39:157–62

40.

Nicholson PHF, Haddaway MJ, Davie MWJ et al (1993) Vertebral deformity, bone mineral density, back pain and height loss in unscreened women over 50 years. Osteoporos Int 3:300–07PubMed

41.

Walker-Bone K, Cooper C, Syddall H et al (2005) Bone mineral density is an independent risk factor for back pain and sciatica among men aged 60–70 years. Rheumatology 44:I111

42.

COST B13 Working Group on Guidelines for Chronic Low Back Pain. European Guidelines for the management of chronic non-specific low back pain: COST B13

43.

Koes BW, van Tulder MW, Ostelo R et al (2001) Clinical guidelines for the management of low back pain in primary care—an international comparison. Spine 26:2504–13PubMed

44.

Khan K, McKay H, Kannus P et al (2001) Physical activity and bone health. Champaign, IL: Human Kinetics

45.

Smeets R, Wittink H, Hidding A et al (2006) Do patients with chronic low back pain have a lower level of aerobic fitness than healthy controls? Are pain, disability, fear of injury, working status, or level of leisure time activity associated with the differences in aerobic fitness level? Spine 31:90–97PubMed

46.

Verbunt JA, Seelen HA, Vlaeyen JW et al (2003) Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Eur J Pain 7:9–21PubMed

47.

Bousema EJ, Verbunt JA, Seelen HAM et al (2007) Disuse and physical deconditioning in the first year after the onset of back pain. Pain 130:279–86PubMed

48.

Thomas JS, France CR (2007) Pain-related fear is associated with avoidance of spinal motion during recovery from low back pain. Spine 32:E460–E66PubMed

49.

Shum GLK, Crosbie J, Lee RYW (2007) Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects. Eur Spine J 16:749–58PubMed

50.

Dieën JHV, Cholewicki J, Radebold A (2003) Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine 28:834–41PubMed

51.

Mok NW, Brauer SG, Hodges PW (2007) Failure to use movement in postural strategies leads to increased spinal displacement in low back pain. Spine 32:E537–E43PubMed

52.

Leboeuf-Yde C (1999) Smoking and low back pain—a systematic literature review of 41 journal articles reporting 47 epidemiologic studies. Spine 24:1463–70PubMed

53.

Goldberg MS, Scott SC, Mayo NE (2000) A review of the association between cigarette smoking and the development of nonspecific back pain and related outcomes. Spine 25:995–1014PubMed

54.

Iwahashi M, Matsuzaki H, Tokuhashi Y et al (2002) Mechanisms of intervertebral disc degeneration caused by nicotine in rabbits to explicate intervertebral disc disorders caused by smoking. Spine 27:1396–401PubMed

55.

Leboeuf-Yde C, Kyvik KO, Bruun NH (1999) Low back pain and lifestyle. Part II—Obesity—information from a population-based sample of 29,424 twin subjects. Spine 24:779–83PubMed

56.

MacInnis RJ, Cassar C, Nowson CA et al (2003) Determinants of bone density in 30 to 65 year-old women: a co-twin study. J Bone Miner Res 18:1650–56PubMed

57.

Zhao LJ, Jiang H, Papasian CJ et al (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 23:17–29PubMed

58.

Nunez NP, Carpenter CL, Perkins SN et al (2007) Extreme obesity reduces bone mineral density: complementary evidence from mice and women. Obesity 15:1980–87PubMed

59.

Goulding A, Taylor RW, Jones IE et al (2002) Spinal overload: a concern for obese children and adolescents? Osteoporos Int 13:835–40PubMed

60.

Goulding A, Taylor RW, Jones IE et al (2000) Overweight and obese children have low bone mass and area for their weight. Int J Obesity 24:627–32

61.

Zhao LJ, Liu YJ, Liu PY et al (2007) Relationship of obesity with osteoporosis. J Clin Endocrinol Metabol 92:1640–46

62.

Tang ZH, Xiao P, Lei SF et al (2007) A bivariate whole-genome linkage scan suggests several shared genomic regions for obesity and osteoporosis. J Clin Endocrinol Metabol 92:2751–57

63.

Lips P (2006) Vitamin D physiology. Prog Biophys Mol Biol 92:4–8PubMed

64.

Liuke M, Solovieva S, Lamminen A et al (2005) Disc degeneration of the lumbar spine in relation to overweight. Int J Obesity 29:903–08

65.

Simpson EK, Parkinson IH, Manthey B et al (2001) Intervertebral disc disorganisation is related to trabecular bone architecture in the lumbar spine. J Bone Miner Res 16:681–87PubMed

66.

Kjaer P, Leboeuf-Yde C, Korsholm L et al (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–80PubMed

67.

Sambrook PN, MacGregor AJ, Spector TD (1999) Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis & Rheumatism 42:366–72

68.

Battie MC, Videman T, Levalahti E et al (2007) Heritability of low back pain and the role of disc degeneration. Pain 131:272–80PubMed

69.

Elfering A, Semmer N, Birkhofer D et al (2002) Young Investigator Award 2001 winner: Risk factors for lumbar disc degeneration—a 5-year prospective MRI study in asymptomatic individuals. Spine 27:125–34PubMed

70.

van Dieën JH, Weinans H, Toussaint HM (1999) Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in aspecific low back pain. Med Hypoth 53:246–52

71.

Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–99PubMed

72.

Kjaer P, Korsholm L, Bendix T et al (2006) Modic changes and their associations with clinical findings. Eur Spine J 15:1312–19PubMed

73.

Kuisma M, Karppinen J, Niinimaki J et al (2007) Modic changes in endplates of lumbar vertebral bodies—prevalence and association with low back and sciatic pain among middle-aged male workers. Spine 32:1116–22PubMed

74.

Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–82PubMed

75.

Arana E, Marti-Bonmati L, Vega M et al (2006) Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiol 35:641–47PubMed

76.

El-Metwally A, Mikkelsson M, Stahl M et al (2008) Genetic and environmental influences on non-specific low back pain in children: a twin study. Eur Spine J 17:502–08PubMed

77.

Hestbaek L, Iachine IA, Leboeuf-Yde C et al (2004) Heredity of low back pain in a young population: a classical twin study. Twin Research 7:16–26PubMed

78.

MacGregor AJ, Andrew T, Sambrook PN et al (2004) Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins. Arthritis Rheum 51:160–67PubMed

79.

Bengtsson B, Thorson J (1991) Back pain: a study of twins. Acta Genet Med Gemellol 40:83–90PubMed

80.

Hartvigsen J, Christensen K, Frederiksen H et al (2004) Genetic and environmental contributions to back pain in old age—a study of 2,108 Danish twins aged 70 and older. Spine 29:897–901PubMed

81.

Videman T, Gibbons LE, Battie MC et al (2001) The relative roles of intragenic polymorphisms of the vitamin D receptor gene in lumbar spine degeneration and bone density. Spine 26:E7–E12PubMed

82.

Zhao LJ, Guo YF, Xiong DH et al (2006) Is a gene important for bone resorption a candidate for obesity? An association and linkage study on the RANK (receptor activator of nuclear factor-kappa B) gene in a large Caucasian sample. Human Genetics 120:561–70PubMed

83.

Battie MC, Levalahti E, Videman T et al (2007) Heritability of lumbar flexibility and the role of disc generation and body weight. J Appl Physiol 104:379–385PubMed

84.

Williams FM, Manek NJ, Sambrook PN et al (2007) Schmorl’s nodes: common, highly heritable, and related to lumbar disc disease. Arthritis Rheum 57:855–60PubMed

85.

Coehlo R, Silva C, Maia A et al (1999) Bone mineral density and depression: a community study in women. J Psychosomatic Res 46:29–35

86.

Altindag O, Altindag A, Asoglu M et al (2007) Relation of cortisol levels and bone mineral density among premenopausal women with major depression. Int J Clin Prac 61:416–20

87.

Jacka FN, Pasco JA, Henry MJ et al (2005) Depression and bone mineral density in a community sample of perimenopausal women: Geelong Osteoporosis Study. Menopause: J North Amer Menopause Soc 12:88–91

88.

Michelson D, Stratakis C, Hill L et al (1996) Bone mineral density in women with depression. New Engl J Med 335:1176–81PubMed

89.

Ekenstam E, Stalenheim G, Hallgren R (1988) The acute effect of high dose corticosteroid treatment on serum osteocalcin. Metabolism 37:141–44PubMed

90.

Manabe T, Takasugi S, Iwamoto Y (2003) Positive relationship between bone mineral density and low back pain in middle-aged women. Eur Spine J 12:596–601PubMed

91.

Schlenker RA, Von Seggen WW (1976) The distribution of cortical and trabecular bone mass along the lengths of the radius and ulna and the implications for in vivo bone mass measurements. Calcif Tiss Int 20:41–52

92.

Erdogan B, Bagis T, Sen O et al (2003) Effects of lumbar disc surgery on bone mineral density in women with lumbar disc disease. Advances in Ther 20:114–20

93.

Bergenudd H, Nilsson B, Uden A et al (1989) Bone mineral content, gender, body posture and build in relation to back pain in middle age. Spine 14:577–79PubMed

94.

Haara MM, Arokoski JPA, Kroger H et al (2007) Relative bone mineral density measured by metacarpal index (MCI) and chronic spinal syndromes: an epidemiological study. Scand J Rheumatol 36:466–69PubMed

95.

O’Sullivan PB (2005) Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanisms. Man Ther 10:242–55PubMed

96.

Gaber T, McGlashan KA, Love S et al (2002) Bone density in chronic low back pain: a pilot study. Clin Rehab 16:867–70

97.

Ho SC, Chan S, Yip V et al (2002) A longitudinal study of low back pain and changes of spinal bone mineral density in Chinese perimenopausal women. J Bone Miner Res 17:S362–S62

98.

Kalkwarf HJ, Specker BL (2002) Bone mineral changes during pregnancy and lactation. Endocrine 17:49–53PubMed

99.

Bjorklund K, Naessen T, Nordstrom ML et al (1999) Pregnancy-related back and pelvic pain and changes in bone density. Acta Obstet Gynecol Scand 78:681–85PubMed

100.

Promislow JHE, Hertz-Picciotto I, Schramm M et al (2004) Bed rest and other determinants of bone loss during pregnancy. Am J Obstet Gynecol 191:1077–83PubMed

101.

Jarvinen M, Kannus P (1997) Current concepts review: injury of an extremity as a risk factor for the development of osteoporosis. J Bone Joint Surg (American) 79:263–76

102.

Jensen B, Wittrup IH, Bliddal H et al (2003) Bone mineral density in fibromyalgia patients—correlation to disease activity. Scand J Rheumatol 32:146–50PubMed

103.

Kroger H, Honkanen R, Saarikoski S et al (1994) Decreased axial bone mineral density in perimenopausal women with rheumatoid arthritis. A population based study. Ann Rheum Dis 53:18–23PubMed

104.

Arriagada M, Arinoviche R (1994) X-ray bone densitometry in the diagnosis and follow-up of reflex sympathetic dystrophy syndrome. J Rheumatol 21:498–500PubMed

105.

Karacan I, Aydin T, Ozaras N (2004) Bone loss in the contralateral asymptomatic hand in patients with complex regional pain syndrome type 1. J Bone Miner Metabol 22:44–47

106.

Whiteside GT, Boulet JM, Sellers R et al (2006) Neuropathy-induced osteopenia in rats is not due to a reduction in weight born on the affected limb. Bone 38:387–93PubMed

107.

Bogdanffy GM, Ohnmeiss DD, Guyer RD (1995) Early changes in bone mineral density above a combined anteroposterior L4–S1 lumbar spinal fusion. A clinical investigation. Spine 20:1674–78PubMed

108.

Jones IE, Taylor RW, Williams SM et al (2002) Four-year gain in bone mineral in girls with and without past forearm fractures: A DXA study. J Bone Miner Res 17:1065–72PubMed

109.

Leppala J, Kannus P, Niemi S et al (1999) An early-life femoral shaft fracture and bone mineral density at adulthood. Osteoporos Int 10:337–42PubMed

110.

Leppala J, Kannus P, Natri A et al (1998) Bone mineral density in the chronic patellofemoral pain syndrome. Calcif Tiss Int 62:548–53

111.

Goulding A, Jones IE, Taylor RW et al (2001) Bone mineral density and body composition in boys with distal. forearm fractures: a dual-energy X-ray absorptiometry study. J Pediatr 139:509–15PubMed

112.

Nielsen SP (2000) The fallacy of BMD: a critical review of the diagnostic use of dual energy X-ray absorptiometry. Clin Rheumatol 19:174–83PubMed

113.

Blake GM, Herd RJM, Fogelman (1996) A longitudinal study of supine lateral DXA of the lumbar spine: a comparison with posteroanterior spine, hip and total-body DXA. Osteoporos Int 6:462–70PubMed

114.

Maricic M, Tesser J, Chen Z et al (1998) How often does lateral spine DXA detect low bone mass in patients with both normal PA spine and hip? J Clin Densitom 1:251–57PubMed

115.

Briggs AM, Wark JD, Kantor S et al (2005) In vivo intra-rater and inter-rater precision of measuring apparent bone mineral density in vertebral subregions using supine lateral dual- energy X-ray absorptiometry (DXA). J Clin Densitom 8:314–19PubMed

116.

Sandor T, Felsenberg D, Brown E (1997) Discriminability of fracture and non-fracture cases based on the spatial distribution of spinal bone mineral. J Comput Assist Tomogr 21:498–505PubMed

117.

Briggs AM, Wark JD, Kantor S et al (2006) Bone mineral density distribution in thoracic and lumbar vertebrae: An ex vivo study using dual energy X-ray absorptiometry. Bone 38:286–88PubMed

118.

Dionne CE, Dunn KM, Croft PR et al (2008) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 33:95–103PubMedCrossRef

119.

World Health Organisation. The implications for training of embracing a life course approach to health. Geneva: World Health Organisation and International Longevity Centre (UK); 2000

Title: Bone health and back pain: What do we know and where should we go?
Authors: A. M. Briggs
L. M. Straker
J. D. Wark
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 2/2009
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-008-0719-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bone health and back pain: What do we know and where should we go?

Abstract

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Please log in to get access to this content

Other articles of this Issue 2/2009

To stop or not to stop, that is the question

The effects of high potassium consumption on bone mineral density in a prospective cohort study of elderly postmenopausal women

Effectiveness of antiresorptives for the prevention of nonvertebral low-trauma fractures in a population-based cohort of women

Changes in soft tissue composition are the primary predictors of 4-year bone mineral density changes in postmenopausal women

Development of a tool for the assessment of calcium and vitamin D intakes in clinical settings

A demonstration project of a multi-component educational intervention to improve integrated post-fracture osteoporosis care in five rural communities in Ontario, Canada