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Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living

Introduction Elderly patients with osteoporosis often complain of back pain associated with pathological vertebral fractures caused by abnormal spinal alignment. Few reports evaluate the relationships among muscle mass, bone mineral density (BMD), sagittal spinal alignment, and low back pain. We hyp...

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Autores principales: Kawakubo, Ayumu, Miyagi, Masayuki, Fujimaki, Hisako, Inoue, Gen, Nakazawa, Toshiyuki, Imura, Takayuki, Saito, Wataru, Uchida, Kentaro, Ohtori, Seiji, Takaso, Masashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212890/
https://www.ncbi.nlm.nih.gov/pubmed/34159032
http://dx.doi.org/10.7759/cureus.15130
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author Kawakubo, Ayumu
Miyagi, Masayuki
Fujimaki, Hisako
Inoue, Gen
Nakazawa, Toshiyuki
Imura, Takayuki
Saito, Wataru
Uchida, Kentaro
Ohtori, Seiji
Takaso, Masashi
author_facet Kawakubo, Ayumu
Miyagi, Masayuki
Fujimaki, Hisako
Inoue, Gen
Nakazawa, Toshiyuki
Imura, Takayuki
Saito, Wataru
Uchida, Kentaro
Ohtori, Seiji
Takaso, Masashi
author_sort Kawakubo, Ayumu
collection PubMed
description Introduction Elderly patients with osteoporosis often complain of back pain associated with pathological vertebral fractures caused by abnormal spinal alignment. Few reports evaluate the relationships among muscle mass, bone mineral density (BMD), sagittal spinal alignment, and low back pain. We hypothesized that decreasing muscle mass in elderly patients with osteoporosis could cause spinal alignment abnormalities. The aim of the current study were to compare the characteristics between spinal sagittal normal alignment and malalignment and to evaluate the relationships between sagittal spinal alignment and muscle mass in elderly patients with osteoporosis. Methods Fifty patients aged 75 years or more (mean age = 80.5 years) with osteoporosis were included in this study. We evaluated the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), the number of vertebral fractures (N of VFs), BMD by dual-energy X-ray absorptiometry, and trunk and skeletal muscle mass using bioelectrical impedance. Low back pain was evaluated using the Oswestry Disability Index (ODI). Corrected trunk muscle mass (trunk muscle mass index, TMI) and corrected limb muscle mass (skeletal mass index, SMI) also were measured. Patients were divided into two groups for comparison: a ‘normal’ group and a sagittal spinal ‘malalignment’ group. Multiple regression analysis was carried out to evaluate the relationship between spinal sagittal parameters and muscle mass. Results Comparisons between normal and malalignment groups for SVA, N of VFs, BMI, and SMI showed significantly higher in the malalignment group versus the normal group (p < 0.05). N of VFs, BMI, and TMI, for PT, and BMI, TMI, SMI, and ODI scores for PI-LL showed significantly higher in the malalignment group versus the normal group (p < 0.05). There were significantly more vertebral fractures in the malalignment group than in the normal group (p < 0.05). However, there were no significant differences of pure muscle mass between the two groups. When adjusted by BMD and the number of vertebral fractures, SMI and TMI were positively correlated to PI-LL and SVA (p < 0.05). Conclusion Elderly patients with osteoporosis and a sagittal spinal malalignment had more vertebral fractures and a higher risk of low back pain than patients with normal spinal alignment. Patients with a sagittal spinal malalignment who were independent and maintained their activities of daily living (ADL) showed high BMI and maintained muscle mass, independent of BMD and the N of VFs, contrary to our hypothesis. 
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spelling pubmed-82128902021-06-21 Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living Kawakubo, Ayumu Miyagi, Masayuki Fujimaki, Hisako Inoue, Gen Nakazawa, Toshiyuki Imura, Takayuki Saito, Wataru Uchida, Kentaro Ohtori, Seiji Takaso, Masashi Cureus Orthopedics Introduction Elderly patients with osteoporosis often complain of back pain associated with pathological vertebral fractures caused by abnormal spinal alignment. Few reports evaluate the relationships among muscle mass, bone mineral density (BMD), sagittal spinal alignment, and low back pain. We hypothesized that decreasing muscle mass in elderly patients with osteoporosis could cause spinal alignment abnormalities. The aim of the current study were to compare the characteristics between spinal sagittal normal alignment and malalignment and to evaluate the relationships between sagittal spinal alignment and muscle mass in elderly patients with osteoporosis. Methods Fifty patients aged 75 years or more (mean age = 80.5 years) with osteoporosis were included in this study. We evaluated the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), the number of vertebral fractures (N of VFs), BMD by dual-energy X-ray absorptiometry, and trunk and skeletal muscle mass using bioelectrical impedance. Low back pain was evaluated using the Oswestry Disability Index (ODI). Corrected trunk muscle mass (trunk muscle mass index, TMI) and corrected limb muscle mass (skeletal mass index, SMI) also were measured. Patients were divided into two groups for comparison: a ‘normal’ group and a sagittal spinal ‘malalignment’ group. Multiple regression analysis was carried out to evaluate the relationship between spinal sagittal parameters and muscle mass. Results Comparisons between normal and malalignment groups for SVA, N of VFs, BMI, and SMI showed significantly higher in the malalignment group versus the normal group (p < 0.05). N of VFs, BMI, and TMI, for PT, and BMI, TMI, SMI, and ODI scores for PI-LL showed significantly higher in the malalignment group versus the normal group (p < 0.05). There were significantly more vertebral fractures in the malalignment group than in the normal group (p < 0.05). However, there were no significant differences of pure muscle mass between the two groups. When adjusted by BMD and the number of vertebral fractures, SMI and TMI were positively correlated to PI-LL and SVA (p < 0.05). Conclusion Elderly patients with osteoporosis and a sagittal spinal malalignment had more vertebral fractures and a higher risk of low back pain than patients with normal spinal alignment. Patients with a sagittal spinal malalignment who were independent and maintained their activities of daily living (ADL) showed high BMI and maintained muscle mass, independent of BMD and the N of VFs, contrary to our hypothesis.  Cureus 2021-05-19 /pmc/articles/PMC8212890/ /pubmed/34159032 http://dx.doi.org/10.7759/cureus.15130 Text en Copyright © 2021, Kawakubo et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Kawakubo, Ayumu
Miyagi, Masayuki
Fujimaki, Hisako
Inoue, Gen
Nakazawa, Toshiyuki
Imura, Takayuki
Saito, Wataru
Uchida, Kentaro
Ohtori, Seiji
Takaso, Masashi
Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living
title Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living
title_full Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living
title_fullStr Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living
title_full_unstemmed Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living
title_short Relationships Between Spinal Alignment and Muscle Mass in Osteoporosis Patients Over 75 Years of Age Who Were Independent and Maintained Their Activities of Daily Living
title_sort relationships between spinal alignment and muscle mass in osteoporosis patients over 75 years of age who were independent and maintained their activities of daily living
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212890/
https://www.ncbi.nlm.nih.gov/pubmed/34159032
http://dx.doi.org/10.7759/cureus.15130
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