Skip to main content
Log in

Impact of spinal kyphosis on gastroesophageal reflux disease symptoms in patients with osteoporosis

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Spinal kyphosis has been speculated to participate in the increased frequency of gastroesophageal reflux disease (GERD) in patients with osteoporosis. The present study provides further evidence that increases in lumbar kyphosis and number of vertebral fractures represent very important risk factors for GERD in patients with osteoporosis.

Introduction

Osteoporosis and spinal kyphosis have been speculated to participate in the increased frequency of gastroesophageal reflux disease (GERD). The present study examined whether GERD in patients with osteoporosis is affected by spinal factors including spinal kyphosis in the presence of oral pharmacotherapies.

Methods

Subjects comprised 112 patients with osteoporosis (mean age, 78 years) who responded to the Frequency Scale for Symptoms of GERD (FSSG) questionnaire, regardless of complaints. Relationships between total FSSG score and number of vertebral fractures, angles of kyphosis, use of bisphosphonates and nonsteroidal anti-inflammatory drugs (NSAIDs), and total number of oral medicines per day were evaluated. Logistic regression identified factors associated with GERD.

Results

Bisphosphonates and NSAIDs did not affect total FSSG score. Total FSSG score showed significant positive correlations with total number of medicines (r = 0.283, p = 0.0025), angle of lumbar kyphosis (r = 0.576, p = 0.0001), and numbers of thoracic vertebral fractures (r = 0.214, p = 0.0232) and lumbar vertebral fractures (r = 0.471, p < 0.0001). Angle of lumbar kyphosis and number of lumbar vertebral fractures were identified by multivariate analysis as indices affecting the presence of GERD.

Conclusion

Increases in angle of lumbar kyphosis and number of lumbar vertebral fractures may5 represent very important risk factors for GERD in osteoporotic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Nevitt MC, Ettinger B, Black DM et al (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800

    PubMed  CAS  Google Scholar 

  2. Martin AR, Sornay-Rendu E, Chandler JM et al (2002) The impact of osteoporosis on quality-of-life: the OFELY cohort. Bone 31:32–36

    Article  PubMed  CAS  Google Scholar 

  3. Miyakoshi N, Itoi E, Kobayashi M et al (2003) Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporos Int 14:1007–1012

    Article  PubMed  CAS  Google Scholar 

  4. Nicholas JA, Wilson PD (1963) Osteoporosis of the aged spine. Clin Orthop Relat Res 26:19–33

    PubMed  CAS  Google Scholar 

  5. Ryan SD, Fried LP (1997) The impact of kyphosis on daily functioning. J Am Geriatr Soc 45:1479–1486

    PubMed  CAS  Google Scholar 

  6. Adachi JD, Loannidis G, Berger C et al (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12:903–908

    Article  PubMed  CAS  Google Scholar 

  7. Adachi JD, Ioannidis G, Olszynski WP et al (2002) The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women. BMC Musculoskelet Disord 3:11

    Article  PubMed  Google Scholar 

  8. Lips P, Cooper C, Agnusdei D et al (1997) Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporos Int 7:36–38

    Article  PubMed  CAS  Google Scholar 

  9. Lips P, Cooper C, Agnusdei D et al (1999) Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporos Int 10:150–160

    Article  PubMed  CAS  Google Scholar 

  10. Miyakoshi N, Hongo M, Maekawa S et al (2007) Back extensor strength and lumbar spinal mobility are predictors of quality of life in patients with postmenopausal osteoporosis. Osteoporos Int 18:1397–1403

    Article  PubMed  CAS  Google Scholar 

  11. Oleksik A, Lips P, Dawson A et al (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392

    Article  PubMed  CAS  Google Scholar 

  12. Silverman SL, Minshall ME, Shen W et al (2001) The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis Rheum 44:2611–2619

    Article  PubMed  CAS  Google Scholar 

  13. Silverman SL, Piziak VK, Chen P et al (2005) Relationship of health related quality of life to prevalent and new or worsening back pain in postmenopausal women with osteoporosis. J Rheumatol 32:2405–1409

    PubMed  Google Scholar 

  14. Yamaguchi T, Sugimoto T, Yamauchi M et al (2005) Multiple vertebral fractures are associated with refractory reflux esophagitis in postmenopausal women. J Bone Miner Metab 23:36–40

    Article  PubMed  Google Scholar 

  15. Blechacz B, Gajic O (2008) Images in clinical medicine. Severe kyphosis. N Engl J Med 358:e28

    Article  PubMed  Google Scholar 

  16. Culham EG, Jimenez HA, King CE (1994) Thoracic kyphosis, rib mobility, and lung volumes in normal women and women with osteoporosis. Spine 19:1250–1255

    Article  PubMed  CAS  Google Scholar 

  17. Leech JA, Dulberg C, Kellie S et al (1990) Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 141:68–71

    PubMed  CAS  Google Scholar 

  18. Mellin G, Harjula R (1987) Lung function in relation to thoracic spinal mobility and kyphosis. Scand J Rehabil Med 19:89–92

    PubMed  CAS  Google Scholar 

  19. Holtmann G (2001) Reflux disease: the disorder of the third millennium. Eur J Gastroenterol Hepatol 13(Suppl 1):S5–S11

    PubMed  Google Scholar 

  20. Watanabe T, Urita Y, Sugimoto M et al (2007) Gastroesophageal reflux disease symptoms are more common in general practice in Japan. World J Gastroenterol 13:4219–4223

    PubMed  Google Scholar 

  21. Furukawa N, Iwakiri R, Koyama T et al (1999) Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J Gastroenterol 34:441–444

    Article  PubMed  CAS  Google Scholar 

  22. Yamaguchi T, Sugimoto T, Yamada H et al (2002) The presence and severity of vertebral fractures is associated with the presence of esophageal hiatal hernia in postmenopausal women. Osteoporos Int 13:331–336

    Article  PubMed  CAS  Google Scholar 

  23. Kusano M, Hashizume K, Ehara Y et al (2008) Size of hiatus hernia correlates with severity of kyphosis, not with obesity, in elderly Japanese women. J Clin Gastroenterol 42:345–350

    Article  PubMed  Google Scholar 

  24. Abraham SC, Cruz-Correa M, Lee LA et al (1999) Alendronate-associated esophageal injury: pathologic and endoscopic features. Mod Pathol 12:1152–1157

    PubMed  CAS  Google Scholar 

  25. Ettinger B, Pressman A, Schein J (1998) Clinic visits and hospital admissions for care of acid-related upper gastrointestinal disorders in women using alendronate for osteoporosis. Am J Manag Care 4:1377–1382

    PubMed  CAS  Google Scholar 

  26. Owen DA (2003) Gastritis and carditis. Mod Pathol 16:325–341

    Article  PubMed  Google Scholar 

  27. Kusano M, Shimoyama Y, Sugimoto S et al (2004) Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J Gastroenterol 39:888–891

    Article  PubMed  Google Scholar 

  28. Orimo H, Hayashi Y, Fukunaga M et al (2001) Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 19:331–337

    Article  PubMed  CAS  Google Scholar 

  29. Kusano M, Shimoyama Y, Kawamura O et al (2007) Proton pump inhibitors improve acid-related dyspepsia in gastroesophageal reflux disease patients. Dig Dis Sci 52:1673–1677

    Article  PubMed  Google Scholar 

  30. Miyakoshi N, Hongo M, Maekawa S et al (2005) Factors related to spinal mobility in patients with postmenopausal osteoporosis. Osteoporos Int 16:1871–1874

    Article  PubMed  Google Scholar 

  31. Orimo H, Shiraki M, Hayashi Y et al (1994) Effects of 1 alpha-hydroxyvitamin D3 on lumbar bone mineral density and vertebral fractures in patients with postmenopausal osteoporosis. Calcif Tissue Int 54:370–376

    Article  PubMed  CAS  Google Scholar 

  32. Donahue JG, Chan KA, Andrade SE et al (2002) Gastric and duodenal safety of daily alendronate. Arch Intern Med 162:936–942

    Article  PubMed  CAS  Google Scholar 

  33. Bone HG, Adami S, Rizzoli R et al (2000) Weekly administration of alendronate: rationale and plan for clinical assessment. Clin Ther 22:15–28

    Article  PubMed  CAS  Google Scholar 

  34. Schnitzer T, Bone HG, Crepaldi G et al (2000) Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis. Alendronate Once-Weekly Study Group. Aging (Milano) 12:1–12

    CAS  Google Scholar 

  35. Fujimoto K (2004) Prevalence and epidemiology of gastro-oesophageal reflux disease in Japan. Aliment Pharmacol Ther 20(Suppl 8):5–8

    Article  PubMed  Google Scholar 

  36. Morris JM, Lucas DB, Bresler B (1961) Role of the trunk in stability of the spine. J Bone Joint Surg Am 43:327–351

    Google Scholar 

  37. Lander JE, Hundley JR, Simonton RL (1992) The effectiveness of weight-belts during multiple repetitions of the squat exercise. Med Sci Sports Exerc 24:603–609

    PubMed  CAS  Google Scholar 

  38. Fink HA, Ensrud KE, Nelson DB et al (2003) Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT). Osteoporos Int 14:69–76

    Article  PubMed  CAS  Google Scholar 

  39. Takemitsu Y, Harada Y, Iwahara T et al (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine 13:1317–1326

    Article  PubMed  CAS  Google Scholar 

  40. Lee CS, Lee CK, Kim YT et al (2001) Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine 26:2029–2035

    Article  PubMed  CAS  Google Scholar 

  41. Chang CS, Poon SK, Lien HC et al (1997) The incidence of reflux esophagitis among the Chinese. Am J Gastroenterol 92:668–671

    PubMed  CAS  Google Scholar 

  42. Petersen H, Johannessen T, Sandvik AK et al (1991) Relationship between endoscopic hiatus hernia and gastroesophageal reflux symptoms. Scand J Gastroenterol 26:921–926

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We wish to thank Drs. Ryoichi Nishiki and Hiroyuki Koto of Eisai Co., Ltd. (Tokyo, Japan) for providing us with self-assessment sheets for the FSSG questionnaire and for valuable discussion during the study.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N. Miyakoshi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miyakoshi, N., Kasukawa, Y., Sasaki, H. et al. Impact of spinal kyphosis on gastroesophageal reflux disease symptoms in patients with osteoporosis. Osteoporos Int 20, 1193–1198 (2009). https://doi.org/10.1007/s00198-008-0777-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-008-0777-x

Keywords

Navigation