Correspondence between bone mineral density and intervertebral disc degeneration across age and sex
The distribution of bone tissue within the vertebra can modulate vertebral strength independently of average density and may change with age and disc degeneration. Our results show that the age-associated decrease in bone density is spatially non-uniform and associated with disc health, suggesting a mechanistic interplay between disc and vertebra.
While the decline of bone mineral density (BMD) in the aging spine is well established, the extent to which age influences BMD distribution within the vertebra is less clear. Measures of regional BMD (rBMD) may improve predictions of vertebral strength and suggest how vertebrae might adapt with intervertebral disc degeneration. Thus, we aimed to assess how rBMD values were associated with age, sex, and disc height loss (DHL).
We measured rBMD in the L3 vertebra of 377 participants from the Framingham Heart Study (41–83 years, 181 M/196 F). Integral (Int.BMD) and trabecular BMD (Tb.BMD) were measured from QCT images. rBMD ratios (anterior/posterior, superior/mid-transverse, inferior/mid-transverse, and central/outer) were calculated from the centrum. A radiologist assigned a DHL severity score to adjacent intervertebral discs (L2–L3 and L3–L4).
Int.BMD and Tb.BMD were both associated with age, though the decrease across age was greater in women (Int.BMD, − 2.6 mg/cm3 per year; Tb.BMD, − 2.6 mg/cm3 per year) than men (Int.BMD, − 0.5 mg/cm3 per year; Tb.BMD, − 1.2 mg/cm3 per year). The central/outer (− 0.027/decade) and superior/mid-transverse (− 0.018/decade) rBMD ratios were negatively associated with age, with similar trends in men and women. Higher Int.BMD or Tb.BMD was associated with increased odds of DHL after adjusting for age and sex. Low central/outer ratio and high anterior/poster and superior/mid-transverse ratios were also associated with increased odds of DHL.
Our results indicate that the distribution of bone within the L3 vertebra is different across age, but not between sexes, and is associated with disc degeneration.
KeywordsAging Vertebral BMD Intervertebral disc degeneration
This study received funding from the National Institute of Health (R01AR054620, R01AR053986, and R01AG041658) and support from the Framingham Heart Study (NIH/NHLBI Contract HHSN268201500001I).
Compliance with ethical standards
Conflict of interest
Ali Guermazi is the President of Boston Imaging Core Lab, LLC. He is a Consultant to MerckSerono, GE, TissueGene, OrthoTrophix, AstraZeneca, Pfizer, and Sanofi.
All participants signed written informed consent before enrollment and examination. Our study was approved by the Institutional Review Board at Boston University Medical Center.
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