Background: It is unclear whether bone quality associates with severity and prognosis of back pain. OBJECTIVES: To investigate the association between bone quality and back pain severity at baseline, and whether low bone quality is a prognostic factor for persistent back pain in patients aged over 55 years at 1-year follow-up. METHODS: In this prospective cohort study persistent back pain was defined as a decrease in the back pain severity score of less than 30% at 1-year follow-up compared with baseline score or as a back pain severity score greater than 1 (0-10: 0 = no pain) Low bone quality was categorized as a T-score, calculated using a stiffness index by quantitative ultrasound of the heel, of 2.5 or below. Data were analyzed in multiple regression analyses. RESULTS: Of all 513 patients, 68 (13%) showed low bone quality at baseline. Back pain severity showed no differences between patients with normal and with low bone quality. At 1-year follow-up, low bone quality was not associated with persistent back pain (defined as < 30%: OR 1.0; 95% CI: 0.40-2.30, p-value = 0.93; and defined as score > 1: OR 0.4; 95% CI: 0.17-1.15), p-value = 0.09), adjusted for all covariates. CONCLUSIONS: In older adults with back pain presenting in general practice, low bone quality was not associated with severity of back pain at baseline nor with persistent back pain at 1-year follow-up.

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Journal of Back and Musculoskeletal Rehabilitation
Department of General Practice

Kim, J.-H. (Jung-Ha), Koes, B., Enthoven, W., Bierma-Zeinstra, S., & Luijsterburg, P. (2018). No association between low bone quality and back pain in older adults: A cohort study. Journal of Back and Musculoskeletal Rehabilitation (Vol. 31, pp. 541–547). doi:10.3233/BMR-170961