Association between low-back pain and lumbar spine bone density: a population-based cross-sectional study

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Abstract
The authors undertook this study to investigate the relationships between low-back pain (LBP) and spinal bone density. Low-back pain is a major health issue and contributes to increases in medical and economic costs. Epidemiological studies have identified individual, sociodemographic, psychosocial, and occupational risk factors for LBP. However, there have been limited studies addressing the relationships between LBP and spinal bone density. Data were obtained from the population-based Fourth Korea National Health and Nutrition Examination Survey (K-NHANES IV, 2009). From 10,533 K-NHANES participants, the authors identified 7144 (3099 men and 4045 women) 21 years of age or older who underwent dual-energy x-ray absorptiometry and anthropometric measurements for inclusion in this study. Low-back pain patients were defined as those who had been diagnosed with LBP by a medical doctor. Chi-square tests, t-tests, and multivariable logistic regression analyses were used to examine the relationships between LBP and spinal bone density. The total prevalence of LBP in the patient sample was 17.1%. More females (21.0%) reported LBP than males (12.1%). A number of sociodemographic and medical factors-sex, age, place of residence, occupation, education, hypertension, diabetes mellitus, and depression-were all associated with LBP, while LBP was not associated with income or exercise levels. Regression analyses indicated that higher lumbar spine T-scores (OR 1.11, 95% CI 1.02-1.20) were associated with LBP. Higher bone density in the lumbar spine is associated with LBP, independent of confounding factors such as sociodemographic status, education, and medical-psychiatric disorders. Cause and effect relationship between higher bone density and LBP, such as degenerative changes in spine, requires further investigation.

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