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The Relationship Between Bone Mineral Density and Lumbar Disc Herniation in Postmenopausal Women

By Admin | September 08, 2023


Introduction: In previous studies, the relationship between BMD (bone mineral density) and LDH (lumbar disc herniation) has been investigated in young people, except for postmenopausal women. The aim of this study was to evaluate this association in postmenopausal women.

Methods: A cross-sectional analysis of 545 consecutive postmenopausal women was performed at a single center. The study included patients aged 45 to 85 with low back pain. Age, weight, height, L1-L4 BMD, L1-L4 T-score, L1-L4 Z-score, femoral neck BMD, femoral neck T-score, and femoral neck Z-score of patients were collected. MRI scans were assessed for the diagnosis of LDH. To explore the impact of the number of herniated segments, patients with LDH were further divided into single-level and multi-level LDH groups.

Results: Five hundred and thirteen postmenopausal women were included in the final analysis. The mean age of the patients was 61.3±8.6 years in the LDH group and 58.4±7.8 years in the non-LDH group (p=0.001). The LDH group had higher lumbar (p<0.001) and femoral neck (p<0.05) BMD, T, and Z-scores than the non-LDH group. In binary logistic regression analysis, age, lumbar, and femoral neck BMD were significantly associated with LDH (p<0.001, p=0.03, and p=0.040, respectively). Patients with multi-level herniation had significantly higher rates of obesity (BMI ≥30) compared to patients with single-level herniation (58.0% vs. 47.0%; p=0.031). However, in terms of obesity rates, the LDH group and the non-LDH group were statistically similar (53.9% vs. 54.2%; p=0.961). There was no association between the single and multi-level herniation groups in terms of L1-4 and femoral neck BMD (p=0.760 and 0.435, respectively).

Conclusion: Higher lumbar bone mineral density and higher femoral neck bone mineral densities were found to be associated with lumber disc herniation in postmenopausal women with low back pain. These results suggest that bone mineral density assessment may be useful in clinical practice to determine which patients are at higher risk of lumbar disc herniation.


Lumbar disc herniation (LDH) is one of the most frequent diseases that has a serious impact on people's quality of life and puts a heavy burden on families and society [1]. It is also the most frequent cause of sciatica and affects 1% to 5% of the population every year [2,3]. Therefore, it is important to elucidate the risk factors and the pathophysiological mechanisms involved in the development of LDH. Clarifying these mechanisms may enable prevention or early diagnosis of the disease. Previously reported associated factors include smoking, genetic factors, occupational factors, and obesity [4-6]. In addition, a recent study reported that symptomatic LDH increases with age, and the incidence is higher in women than in men [7].

Since bone mineral density (BMD) levels affect not only the structure of bones but also nonosseous tissues, osteopenia and osteoporosis disrupt the morphology of lumbar vertebral bones and intervertebral discs [8,9]. On the other hand, it has also been shown that stronger bones may be associated with more disc degeneration [9]. Nevertheless, although lumbar vertebral bones and lumbar intervertebral discs are close to each other both biomechanically and anatomically, to our knowledge, the association between BMD and LDH has not been studied in postmenopausal women before. Two studies were detected evaluating this relationship in young healthy people living in an urban area and young patients, with the exclusion of postmenopausal women, and the studies found no significant relationship [10,11].

Close contact between the vertebral bone marrow and the vertebral endplate is important for adequate nutrition of the nucleus pulposus of the disc [12]. High BMD causes increased end-plate resistance and affects the vascularization of the disc by disrupting diffusion [13]. Furthermore, high BMD may cause higher vertebral stiffness, and by this mechanism, mechanical stress on the disc may cause repetitive tears in the annulus fibrosus and result in compression and herniation of the disc [14]. As the accumulation of small tears in the disc through these mechanical and vascular pathophysiological pathways occurs over many years, and the structure of the disc is stronger in young adults, high BMD may not result in...(More)

For more info please read, The Relationship Between Bone Mineral Density and Lumbar Disc Herniation in Postmenopausal Women, by Cureus

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