Osteoporosis International

, Volume 7, Issue 6, pp 564–569 | Cite as

Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women

  • G. Liu
  • M. Peacock
  • O. Eilam
  • G. Dorulla
  • E. Braunstein
  • C. C. Johnston
Original Article


To determine in the elderly the effect of osteoarthritis on bone mineral density (BMD) and on diagnosis of osteoporosis, lumbar spine and hip were radiographed and BMD measured by dual-energy X-ray absorptiometry (DXA) in 120 men and 314 women, aged 60–99 years. Prevalence and severity of osteoarthritis were scored on osteophytes, joint space narrowing and bone sclerosis. Ultrasound measurements were also made at the heel to examine whether osteoarthritis at hip or lumbar spine influence bone at this remote site. Osteophytes were the commonest feature, with men having a higher prevalence than women, and lumbar spine having more disease than hip. Lumbar spine osteophytes affected 75% of men and 61.1% of women, and hip osteophytes affected 31.7% of men and 27.4% of women. Stepwise multiple regression analysis using age, weight, height, osteophytes, sclerosis and joint space narrowing indicated that lumbar osteophytes explained 16.6% of variation in lumbar spine BMD in women, and 22.4% in men. Hip osteophytes had a minimal effect on hip BMD, accounting for only 2.2% of variation in women, and none in men. Sclerosis and joint narrowing had little effect on BMD at lumbar spine or hip. Indirect effects of osteoarthritis on BMD were small and inconsistent across genders. Lumbar spine osteophytes in men explained 3.1% of hip BMD variation and 6% of variation in speed of sound at the heel, whereas hip osteophytes in women explained 2.2% of lumbar spine BMD variation. Osteoporosis at the hip, defined as BMD <2.5 SD of the young normal mean, was present in 33.1% of women and 25.8% of men, whereas, at the lumbar spine it was present in only 24.2% of women and 4.2% of men. However, in women and men free of spinal osteoarthritis, 37.7% of women and 10% of men had osteoporosis. We conclude that lumbar spine ostoephytes affect most subjects over the age of 60 years, and contribute substantially to lumbar spine BMD measured in the anteroposterior position by DXA. The effect is largely direct by virtue of osteophytes being included in the BMD measurement. However, a small indirect effect on remote skeletal sites is also present. Diagnosis of osteoporosis and assessment of osteoporotic fracture risk in the elderly should be based on hip BMD and not on anteroposterior lumbar spine, unless spinal osteoarthritis has been excluded.


Bone mineral density Dual-energy X-ray absorptiometry Hip Osteoarthritis Osteoporosis Lumbar spine 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N. Perspective: the diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137–41.PubMedGoogle Scholar
  2. 2.
    Nordin BEC, Wishart J, Horowitz M, Need A, Need AS, Bridges A, Bellon M. The relation between forearm and vertebral mineral density and fractures in postmenopausal women. Bone Miner 1988;5:21–33.PubMedCrossRefGoogle Scholar
  3. 3.
    Burger H, van Daele PLA, Algra D, et al. The association between age and bone mineral density in men and women aged 55 years and over: the Rotterdam Study. Bone Miner 1994;25:1–13.PubMedGoogle Scholar
  4. 4.
    Melton LJ III, Atkinson EJ, O’Fallon WM, Wahner HW, Riggs BL. Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 1993;8:1227–33.PubMedGoogle Scholar
  5. 5.
    Mazess RB, Barden H, Ettinger M, et al. Spine and femur density using dual-photon absorptiometry in US white women. Bone Miner 1987;2:211–9.PubMedGoogle Scholar
  6. 6.
    Mazess RB, Barden HS, Drinka PJ, Bauwens SF, Orwoll ES, Bell NH. Influence of age and body weight on spine and femur bone mineral density in US white men. J Bone Miner Res 1990;5:645–52.PubMedGoogle Scholar
  7. 7.
    Engelke K, Glüer CC, Genant HK. Factors influencing short-term precision of dual X-ray bone absorptiometry (DXA) of spine and femur. Calcif Tissue Int 1995;56:19–25.PubMedCrossRefGoogle Scholar
  8. 8.
    Williams-Russo P, Healey JH, Szatrowski TP, et al. Clinicial reproducibility of dual energy X-ray absorptiometry. J Orthop Res 1995;13:250–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Genant HK, Engelke K, Fuerst T, et al. Noninvasive assessment of bone mineral and structure: state of the art. J Bone Miner Res 1996;11:707–30.PubMedGoogle Scholar
  10. 10.
    Turner CH, Peacock M, Timmerman L, Neal JM, Johnston CCJ. Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Osteoporos Int 1995;5:130–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Hans D, Dargent-Molina P, Schott AM, et al. Ultrasonographic heel measurements to predict hip fracture in elderly women: the EPIDOS prospective study. Lancet 1996;348:511–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Heaney RP, Avioli LV, Chesnut CI, Lappe J, Recker RR. Osteoporotic bone fragility. JAMA 1989;261:2986–90.PubMedCrossRefGoogle Scholar
  13. 13.
    Lawrence RC, Hochberg MC, Kelsey JL, et al. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. Journal Rheumatol 1989;16:427–41.Google Scholar
  14. 14.
    Van Saase JLCM, Van Romunde LKJ, Cats A, Vandenbroucke JP, Valkenburg HA. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis 1989;48:271–80.PubMedGoogle Scholar
  15. 15.
    Orwoll ES, Oviatt SK, Mann T. The impact of osteophytic and vascular calcifications on vertebral mineral density measurements in men. J Clin Endocrinol Metab 1990;70:1202–7.PubMedGoogle Scholar
  16. 16.
    Reid IR, Evans MC, Ames R, Wattie DJ. The influence of osteophytes and aortic calcification on spinal mineral density in postmenopausal women. J Clin Endocrinol Metab 1991;72:1372–4.PubMedGoogle Scholar
  17. 17.
    Jones G, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA. A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly. J Rheumatol 1995;22:932–6.PubMedGoogle Scholar
  18. 18.
    Greenspan SL, Maitland LA, Myers ER, Kransnow MB, Kido TH. Femoral bone loss progresses with age: A longitudinal study in women over age 65. J Bone Miner Res 1994;9(12):1959–65.PubMedCrossRefGoogle Scholar
  19. 19.
    Peacock DJ, Egger P, Taylor P, Cawley MID, Cooper C. Lateral bone density measurements in osteoarthritis of the lumbar spine. Ann Rheum Dis 1996;55:196–8.PubMedGoogle Scholar
  20. 20.
    Burger H, van Daele PLA, Odding E, et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. Arthritis Rheum 1996;39:81–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Ryan PJ, Spector TP, Blake GM, Doyle DV, Fogelman I. A comparison of reference bone mineral density measurements derived from two sources: referred and population based. Br J Radiol 1993;66:1138–41.PubMedCrossRefGoogle Scholar
  22. 22.
    Dequeker J, Mokassa L, Aerssens J. Bone density and osteoarthritis. J Rheumatol 1995;22 (Suppl 43):98–100.Google Scholar
  23. 23.
    Boyde A, Jones SJ, Aerssens J, Dequeker J. Mineral density quantitation of the human cortical iliac crest by backscattered electron image analysis: variations with age, sex, and degree of osteoarthritis. Bone 1995;16:619–27.PubMedCrossRefGoogle Scholar
  24. 24.
    Zagzebski JA, Rossman PJ, Mesina C, Mazess RB, Madsen EL. Ultrasound transmission measurements through the os calcis. Calcif Tissue Int 1991;49:107–11.PubMedCrossRefGoogle Scholar
  25. 25.
    Lane NE, Nevitt MC, Genant HK, Hochberg MC. Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol 1993;20:1911–8.PubMedGoogle Scholar
  26. 26.
    Kellgren JH, Lawrence JS. Radiological JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16:494–502.PubMedCrossRefGoogle Scholar
  27. 27.
    Nevitt MC, Lane NE, Scott JC, et al. Radiographic osteoarthritis of the hip and bone mineral density. Arthritis Rheum 1995;38:907–16.PubMedCrossRefGoogle Scholar
  28. 28.
    Hochberg MC, Lethbridge-Cejku M, Scott WW Jr, Plato CC, Tobin JD. Appendicular bone mass and osteoarthritis of the hands in women: data from the Baltimore Longitudinal Study of Aging. J Rheumatol 1994;21:1532–6.PubMedGoogle Scholar

Copyright information

© European Foundation for Osteoporosis and the National Osteoporosis Foundation 1997

Authors and Affiliations

  • G. Liu
    • 1
  • M. Peacock
    • 1
  • O. Eilam
    • 2
  • G. Dorulla
    • 3
  • E. Braunstein
    • 3
  • C. C. Johnston
    • 1
  1. 1.Department of MedicineIndiana University School of MedicineUSA
  2. 2.Department of Internal MedicineRambam Medical CenterHaifaIsrael
  3. 3.Department of RadiologyUniversity HospitalIndianapolisUSA

Personalised recommendations