Skip to main content
SpringerLink
Log in

Heritability of spinal curvature and its relationship to disc degeneration and bone mineral density in female adult twins

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To determine the heritability of spine curve using plain radiographs and to identify risk factors for spine curvature including age, body mass index, smoking, bone mineral density (BMD), and lumbar disc degeneration (LDD).

Methods

A classical twin study of 110 MZ and 136 DZ adult female twins. Demographic and clinical information obtained from long spine radiographs, lumbar spine degeneration on spine MR scan, and BMD assessed by DEXA at hip and lumbar spine were included in multiple logistic regression models to determine risk factors for spine curvature.

Results

Heritability estimates ranged between 41 (19–59) % for pelvic incidence to 61 (46–72) % for thoracic kyphosis; with lumbar lordosis and cervical lordosis having 59 (42–71) % and 43 (23–59) % heritability, respectively. For each spine curve, the model showing the best fit contained additive genetic and shared environmental components with no contribution from the unique environment. Significant risk factors for increased thoracic kyphosis were lumbar spine BMD, age, and cervical lordosis; for pelvic incidence were lumbar spine BMD and lumbar lordosis; for lumbar lordosis were cervical lordosis, pelvic incidence and LDD; and age alone predicted cervical lordosis (p = 0.001).

Conclusion

In this sample of middle-aged and elderly women, there were significant genetic influences on all spine curves but particularly thoracic kyphosis and lumbar lordosis. The strongest predictor for lumbar lordosis was LDD (p < 0.0001) which is itself genetically determined in part. For thoracic kyphosis, BMD was strongly associated and remained so (for lumbar BMD) with the inclusion of age, showing BMD to be an independent risk factor. This work highlights the genetic factors influencing normal spine curvature in women.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30(6):682–688

    Article  Google Scholar 

  2. Schwab F, Lafage V, Shaffrey CI et al (2012) The Schwab-SRS adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and non-operative cohort. Neurosurgery 71(2):E556. doi:10.1227/01.neu.0000417728.42473.0b

    Article  Google Scholar 

  3. Glassman SD, Carreon LY, Anderson PA, Resnick DK (2011) A diagnostic classification for lumbar spine registry development. Spine J 11(12):1108–1116. doi:10.1016/j.spinee.2011.11.016

    Article  PubMed  Google Scholar 

  4. Battie MC, Videman T (2006) Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am 88(Suppl 2):3–9. doi:10.2106/jbjs.e.01313

    Article  PubMed  Google Scholar 

  5. Waris E, Eskelin M, Hermunen H, Kiviluoto O, Paajanen H (2007) Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging. Spine 32(6):681–684. doi:10.1097/01.brs.0000257523.38337.96

    Article  PubMed  Google Scholar 

  6. de Schepper EI, Damen J, van Meurs JB et al (2010) The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine (Phila Pa 1976) 35(5):531–536. doi:10.1097/BRS.0b013e3181aa5b33

    Article  Google Scholar 

  7. Burkett B, Ricart-Hoffiz PA, Schwab F et al (2012) Comparative analysis of surgical approaches and osteotomies for the correction of sagittal plane spinal deformity in adults. Spine (Phila Pa 1976) 38:188–194. doi:10.1097/BRS.0b013e318266b816

    Article  Google Scholar 

  8. Livshits G, Popham M, Malkin I et al (2011) Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK twin spine study. Ann Rheum Dis 70(10):1740–1745. doi:10.1136/ard.2010.137836

    Article  PubMed Central  PubMed  Google Scholar 

  9. Andrew T, Hart DJ, Snieder H, de Lange M, Spector TD, MacGregor AJ (2001) Are twins and singletons comparable? A study of disease-related and lifestyle characteristics in adult women. Twin Res 4(6):464–477

    Article  CAS  PubMed  Google Scholar 

  10. Sambrook PN, MacGregor AJ, Spector TD (1999) Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 42(2): 366–372

  11. Williams FM, Popham M, Sambrook PN, Jones AF, Spector TD, MacGregor AJ (2011) Progression of lumbar disc degeneration over a decade: a heritability study. Ann Rheum Dis 70(7):1203–1207. doi:10.1136/ard.2010.146001

    Article  PubMed Central  PubMed  Google Scholar 

  12. Richards JB, Rivadeneira F, Inouye M et al (2008) Bone mineral density, osteoporosis, and osteoporotic fractures: a genome-wide association study. Lancet 371(9623):1505–1512. doi:10.1016/s0140-6736(08)60599-1

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Morel E, Ilharreborde B, Lenoir T et al (2005) Sagittal balance of the spine and degenerative spondylolisthesis. Rev Chir Orthop Reparatrice Appar Mot 91(7):615–626

    Article  CAS  PubMed  Google Scholar 

  14. Neale M, Cordon LR (eds) (1992) Methodology for genetic studies for twins and families. Kluwer Academic Publisher, The Netherlands

    Google Scholar 

  15. Rhee SH, Neale MC, Corley RC, Hewitt JK (2007) The inclusion of measured covariates in the Neale and Kendler model fitting approach. Behav Genet 37(2):423–432. doi:10.1007/s10519-006-9130-3

    Article  PubMed  Google Scholar 

  16. Akaike H (1974) Akaike’s information criterion (AIC). IEEE Trans Automa Control 19

  17. Jensen TS, Karppinen J, Sorensen JS, Niinimaki J, Leboeuf-Yde C (2008) Vertebral endplate signal changes (modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17(11):1407–1422. doi:10.1007/s00586-008-0770-2

    Article  PubMed Central  PubMed  Google Scholar 

  18. MacGregor AJ, Andrew T, Sambrook PN, Spector TD (2004) Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins. Arthritis Rheum 51(2):160–167. doi:10.1002/art.20236

    Article  PubMed  Google Scholar 

  19. Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C (2008) Modic changes, possible causes and relation to low back pain. Med Hypotheses 70(2):361–368. doi:10.1016/j.mehy.2007.05.014

    Article  CAS  PubMed  Google Scholar 

  20. Livshits G, Ermakov S, Popham M et al (2010) Evidence that bone mineral density plays a role in degenerative disc disease: the UK twin spine study. Ann Rheum Dis 69(12):2102–2106. doi:10.1136/ard.2010.131441

    Article  PubMed Central  PubMed  Google Scholar 

  21. Jimbo S, Kobayashi T, Aono K, Atsuta Y, Matsuno T (2012) Epidemiology of degenerative lumbar scoliosis: a community-based cohort study. Spine (Phila Pa 1976) 37(20):1763–1770. doi:10.1097/BRS.0b013e3182575eaa

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank spine surgeon Khai Lam for his input into the study. Also, Maria Popham for her help with the heritability analysis and the Radiology Department of the London Bridge Hospital for performing the follow-up MR scans and plain radiographs. TwinsUK: was funded by the Wellcome Trust; European Community’s Seventh Framework Programme (FP7/2007-2013). The study also receives support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London.

Conflict of interest

None of the authors declare any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Twin Research and Genetic Epidemiology, St Thomas’ Hospital, King’s College London, London, SE1 7EH, UK

    Millicent A. Stone, Daniel-Clement Osei-Bordom, Lisa E. Wolber & Frances M. K. Williams

  2. University of Bath, Bath, UK

    Millicent A. Stone & Cormac Sammon

  3. Toronto Western Research Institute, Toronto, Canada

    Robert D. Inman

Authors
  1. Millicent A. Stone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel-Clement Osei-Bordom
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert D. Inman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cormac Sammon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lisa E. Wolber
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frances M. K. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frances M. K. Williams.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stone, M.A., Osei-Bordom, DC., Inman, R.D. et al. Heritability of spinal curvature and its relationship to disc degeneration and bone mineral density in female adult twins. Eur Spine J 24, 2387–2394 (2015). https://doi.org/10.1007/s00586-014-3477-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-014-3477-6

Keywords

Search

Navigation