Amanda L Lorbergs1,2,3, Brett T Allaire4, Laiji Yang1, Douglas P Kiel1,2,3, L Adrienne Cupples5,6, Mohamed Jarraya7, Ali Guermazi8, Thomas G Travison1,2,3, Mary L Bouxsein4,9, Dennis E Anderson4,9, Elizabeth J Samelson1,2,3. 1. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts. 2. Department of Medicine, Harvard Medical School, Boston, Massachusetts. 3. Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 4. Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 5. School of Public Health, Boston University, Boston, Massachusetts. 6. The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts. 7. Mercy Catholic Medical Center, Philadelphia, Pennsylvania. 8. Quantitative Imaging Center, Boston University School of Medicine, Boston, Massachusetts. 9. Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Cross-sectional studies suggest that trunk muscle morphology in the lumbar spine is an important determinant of kyphosis severity in older adults. The contribution of age-related changes in muscle morphology in the thoracic and lumbar spine to progression of kyphosis is not known. Our objective was to determine cross-sectional and longitudinal associations of thoracic and lumbar muscle size and density with kyphosis. METHODS: Participants were 1,087 women and men (mean age: 61 years) of the Framingham Heart Study who underwent baseline and follow-up quantitative computed tomography (QCT) scanning 6 years apart. We used QCT scans to measure trunk muscle cross-sectional area (CSA, cm2) and density (HU) at the thoracic and lumbar spine and Cobb angle (degrees) from T4 to T12. Linear regression models estimated the association between muscle morphology and kyphosis. RESULTS: At baseline, smaller muscle CSA and lower density of thoracic (but not lumbar) spine muscles were associated with a larger (worse) Cobb angle in women and men. For example, each standard deviation decrease in baseline thoracic paraspinal muscle CSA was associated with a larger baseline Cobb angle in women (3.7 degrees, 95% CI: 2.9, 4.5) and men (2.5 degrees, 95% CI: 1.6, 3.3). Longitudinal analyses showed that loss of muscle CSA and density at the thoracic and lumbar spine was not associated with progression of kyphosis. CONCLUSIONS: Our findings suggest that kyphosis severity is related to smaller and lower density trunk muscles at the thoracic spine. Future studies are needed to determine how strengthening mid-back musculature alters muscle properties and contributes to preventing kyphosis progression.
BACKGROUND: Cross-sectional studies suggest that trunk muscle morphology in the lumbar spine is an important determinant of kyphosis severity in older adults. The contribution of age-related changes in muscle morphology in the thoracic and lumbar spine to progression of kyphosis is not known. Our objective was to determine cross-sectional and longitudinal associations of thoracic and lumbar muscle size and density with kyphosis. METHODS:Participants were 1,087 women and men (mean age: 61 years) of the Framingham Heart Study who underwent baseline and follow-up quantitative computed tomography (QCT) scanning 6 years apart. We used QCT scans to measure trunk muscle cross-sectional area (CSA, cm2) and density (HU) at the thoracic and lumbar spine and Cobb angle (degrees) from T4 to T12. Linear regression models estimated the association between muscle morphology and kyphosis. RESULTS: At baseline, smaller muscle CSA and lower density of thoracic (but not lumbar) spine muscles were associated with a larger (worse) Cobb angle in women and men. For example, each standard deviation decrease in baseline thoracic paraspinal muscle CSA was associated with a larger baseline Cobb angle in women (3.7 degrees, 95% CI: 2.9, 4.5) and men (2.5 degrees, 95% CI: 1.6, 3.3). Longitudinal analyses showed that loss of muscle CSA and density at the thoracic and lumbar spine was not associated with progression of kyphosis. CONCLUSIONS: Our findings suggest that kyphosis severity is related to smaller and lower density trunk muscles at the thoracic spine. Future studies are needed to determine how strengthening mid-back musculature alters muscle properties and contributes to preventing kyphosis progression.
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