Context. Lumbar spine degenerative changes are common and have been associated with both low back pain and impaired physical function. There have been few studies describing frequencies and associations across lumbar spine radiographic features (IRF). Radiography, however, has limitations regarding cartilage and synovial tissue changes whereas OA biomarkers may help to understand the biological process of degeneration. There has been limited investigation between OA biomarkers and lumbar spine IRF although the biochemical makeup of the lumbar spine would warrant investigation.
Objectives. These analyses were conducted in a large US community-based bi-racial sample to meet the following objectives: (1) determine the prevalence of disc space narrowing (DSN), vertebral osteophytes (OST) and facet joint OA (FOA) in the lumbar spine, (2) describe the frequency of demographic, clinical and concomitant knee, hip and hand OA across severity of lumbar spine DSN, vertebral OST and presence of FOA, (3) determine the association between demographic, clinical and concomitant peripheral joint OA with lumbar spine individual radiographic features of DSN and vertebral OST, (4) determine if an association exists between lumbar spine IRF and serum and urine OA biomarkers and (5) determine if associations between serum and urine OA biomarkers differ significantly across gender, race and low back symptoms.
Methods. A cross section of data with 1,015 subjects that completed clinical interview from a community-based cohort (2003–2004). Individual radiographic features were available on 840 subjects examined for objectives 1, 2 and 3 were DSN and anterior vertebral OST (both graded for severity on a 0–3 scale from the Burnett Atlas), and facet joint OA (FOA) [graded as absent or present]. Low back symptoms were captured by self-report. Biomarkers examined for objectives 4 and 5 were c-terminal telopeptide of type II collagen (CTX-II) measured on 537 subjects, hyaluronic Acid (HA), cartilage oliogometric protein (COMP), Col2-3/4C (C2C), propeptide of type II procollagen (CPII) measured on 555 subjects and N-Terminal Telopeptide (NTX-I) measured on 554 subjects. Associations were determined with each lumbar spine IRF and OA biomarker by proportional odds, partial proportional odds and binary logistic regression models while adjusting for age, gender, BMI, race, low back symptoms, hip OA, knee OA, and hand OA.
Results. The prevalence estimates of lumbar spine IRF were similar between DSN and FOA, whereas the prevalence of OST was much greater and differed by race and gender. Body mass index dichotomized at 30 kg/m 2 was associated with OST and FOA but not DSN. In contrast, males were less likely to have DSN and FOA but a strong association was noted with OST. African Americans were less likely to have FOA when compared to Caucasians. Low back symptoms were not associated with OST or FOA and demonstrated a modest association with DSN. The relationship between concomitant knee hip and hand OA demonstrated similarities and variations across lumbar spine IRF. Knee OA was independently associated only with OST and FOA whereas hand OA demonstrated a strong association only with FOA. Hip OA demonstrated no association with any of the lumbar spine IRF. Variations were also observed with associations between lumbar spine IRF and OA biomarkers. Type II collagen OA biomarkers demonstrated the strongest association with DSN whereas there was no association with OST. Type I collagen and non-collagenous protein markers were weaker but continued to demonstrate a stronger association with DSN when compared to OST. Differences across gender were found between DSN and HA and NTX-I and OST. Racial differences were found between OST and NTX-I. Among those with self-reported low back symptoms there was a strong association between DSN and COMP.
Conclusion. The variations in associations suggest that lumbar spine IRF may have a different degenerative process from one another and of concomitant knee, hip and hand OA. Osteoarthritis biomarkers studied here reflect the biological differences in the process of degeneration between DSN and OST.
|Advisor:||Marshall, Stephen W.|
|Commitee:||Carey, Timothy S., Irwin, Debra E., Jordan, Joanne M., Kraus, Virginia B., Sturmer, Til|
|School:||The University of North Carolina at Chapel Hill|
|School Location:||United States -- North Carolina|
|Source:||DAI-B 73/06, Dissertation Abstracts International|
|Keywords:||Biomarkers, Individual radiographic features, Lumbar spine, Osteoarthritis|
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