THE PREVALENCE OF LOW BONE DENSITY IN WOMEN WITH NEURGENIC CLAUDICATION

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Context: Osteoporosis is a major health issue facing our aging population. It is a bone disease characterized by decreased bone mass leading to fragility and fracture. Many skeletal degenerative disorders like osteoarthritis and spinal stenosis are characterized by local increased bone density, which can mask generalized loss of bone mass. The relationship between osteoporosis and other degenerative musculoskeletal disorders is unknown and has particular relevance as both types of disorders increase with age. A useful first step in exploring this relationship is to establish the prevalence of low bone density in patients with degenerative disorders, like spinal stenosis. Further, regional bone density in the spine can be compared with other areas. Objectives: The presence of neurogenic claudication defines a group of patients who are symptomatically affected by spinal stenosis. The primary aim is to perform a cross-sectional study of subjects with neurogenic claudication to establish the prevalence of regional decreases in bone mineral density in subjects with symptomatic spinal stenosis, a common degenerative disorder of the axial skeleton. Secondary aims include comparisons between the bone density of the spine and those of other regions in this group. This study represents the preliminary steps to a larger research project exploring the relationships between degenerative musculoskeletal conditions and bone density. Design and Subjects: This is a prospective study of a population of women presenting to a tertiary care spine center for evaluation of a spinal problem. All women over 50 are eligible and asked to complete our standard intake forms for both spinal problems and osteoporosis risk. Those diagnosed with neurogenic claudication (symptomatic spinal stenosis) will be asked to participate. The clinical diagnosis will be confirmed with the Swiss Spinal Stenosis Questionnaire and Shuttle Walking Test. Dual-energy x-ray absorptiometry (DXA) scans of the proximal femur, nondominant forearm and lumbar spine will be obtained. Serum and urine markers will be used to measure menopausal status and bone turnover. Descriptive variables collected will include age, medical history, osteoporosis risk factors, self-reported function and health status, and objective ambulatory ability among others. Bone mineral density will be used to determine the presence or absence of osteoporosis or low bone mass and treatment recommendations initiated if necessary. Potential Impact: The ability to move forward with research into spinal degeneration requires characterization of coexisting skeletal disorders. If bone density changes are prevalent in subjects with spinal stenosis then this population offers an opportunity for research to improve our understanding of the relationship between activity, skeletal health, and therapies directed at increasing physical activity as a component of musculoskeletal health care. These findings may also help define the etiology of spinal stenosis in this population.