Mohamed Jarraya1, Ali Guermazi1, Amanda L Lorbergs2, Elana Brochin3, Douglas P Kiel2, Mary L Bouxsein4, L Adrienne Cupples5, Elizabeth J Samelson6. 1. Quantitative Imaging Center, Boston University School of Medicine, 820 Harrison Ave, 3rd Floor, Boston, MA 02118, USA. 2. Institute for Aging Research, Hebrew SeniorLife, 1200 Center St, Boston, MA 02131, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA. 3. Institute for Aging Research, Hebrew SeniorLife, 1200 Center St, Boston, MA 02131, USA. 4. Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, RN115, 330 Brookline Ave, Boston , MA 02215, USA; Department of Orthopedic Surgery, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. 5. Department of Biostatistics and Epidemiology, Boston University School of Public Health, Crosstown Building, 801 Massachusetts Ave, 3rd Floor, Boston, MA 02118, USA; Framingham Heart Study, 73 Mt Wayte Ave, Framingham, MA, 01702, USA. 6. Institute for Aging Research, Hebrew SeniorLife, 1200 Center St, Boston, MA 02131, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA. Electronic address: samelson@hsl.harvard.edu.
Abstract
BACKGROUND CONTEXT: Prevalence and progression of disc height narrowing (DHN) and facet joint osteoarthritis (FJOA) in the thoracic and lumbar regions in non-clinical populations are not well established. PURPOSE: The present study aimed to use computed tomography (CT) images to determine the prevalence and progression of DHN and FJOA according to age, sex, and spinal region. STUDY DESIGN: This is a 6-year longitudinal study. SAMPLE: A total of 1,195 members of the Framingham Study (mean baseline age 61±9 years) were included in the study. OUTCOME MEASURES: We compared the prevalence and progression (new or worsening) of moderate-to-severe DHN and FJOA by age, sex, and spinal region. METHODS: A musculoskeletal radiologist evaluated DHN and FJOA from T4/T5 to L4/L5 on baseline and follow-up CT images using a semi-quantitative scale: 0=normal, 1=mild, 2=moderate, and 3=severe. RESULTS: One-third or more of women and men ages 40-59 years at baseline had imaged-based evidence of prevalent DHN, more than half had prevalent FJOA, and DHN and FJOA prevalence increased approximately two- to fourfold in those age 60-69 and 70-89 years at baseline, respectively (p<.01). Progression of DHN and FJOA occurred more frequently at the lumbar than at the thoracic spine and more in women than in men (DHN: odds ratio [OR]=1.42, 95% confidence interval [CI]=1.07, 1.88; FJOA: OR=1.70, CI=1.33, 2.17). CONCLUSIONS: Prevalence and progression of moderate-to-severe DHN and FJOA are common in non-clinical populations of older adults. The high frequency of spinal degeneration observed on CTs in this community-based study may contribute to challenges in interpreting the clinical significance of imaging evidence of DHN and FJOA. Future studies investigating the association of CT-based spinal degenerative features with pain and functional impairments in population-based samples are needed to help determine the clinical significance of imaged-based findings of DHN and FJOA.
BACKGROUND CONTEXT: Prevalence and progression of disc height narrowing (DHN) and facet joint osteoarthritis (FJOA) in the thoracic and lumbar regions in non-clinical populations are not well established. PURPOSE: The present study aimed to use computed tomography (CT) images to determine the prevalence and progression of DHN and FJOA according to age, sex, and spinal region. STUDY DESIGN: This is a 6-year longitudinal study. SAMPLE: A total of 1,195 members of the Framingham Study (mean baseline age 61±9 years) were included in the study. OUTCOME MEASURES: We compared the prevalence and progression (new or worsening) of moderate-to-severe DHN and FJOA by age, sex, and spinal region. METHODS: A musculoskeletal radiologist evaluated DHN and FJOA from T4/T5 to L4/L5 on baseline and follow-up CT images using a semi-quantitative scale: 0=normal, 1=mild, 2=moderate, and 3=severe. RESULTS: One-third or more of women and men ages 40-59 years at baseline had imaged-based evidence of prevalent DHN, more than half had prevalent FJOA, and DHN and FJOA prevalence increased approximately two- to fourfold in those age 60-69 and 70-89 years at baseline, respectively (p<.01). Progression of DHN and FJOA occurred more frequently at the lumbar than at the thoracic spine and more in women than in men (DHN: odds ratio [OR]=1.42, 95% confidence interval [CI]=1.07, 1.88; FJOA: OR=1.70, CI=1.33, 2.17). CONCLUSIONS: Prevalence and progression of moderate-to-severe DHN and FJOA are common in non-clinical populations of older adults. The high frequency of spinal degeneration observed on CTs in this community-based study may contribute to challenges in interpreting the clinical significance of imaging evidence of DHN and FJOA. Future studies investigating the association of CT-based spinal degenerative features with pain and functional impairments in population-based samples are needed to help determine the clinical significance of imaged-based findings of DHN and FJOA.
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