Does Increased Lumbar Lordosis Promote Osteoporosis of The Lumbar Spine?

Objective: Increasing thoracic kyphosis is a typical clinical feature of osteoporosis. Recent clinical studies suggest a correlation between increased lumbar lordosis and lumbar bone mineral density (BMD). The aim of this study was to investigate the relationship between lumbar lordosis and BMD. Subjects and Methods: All postmenopausal patients who had undergone DEXA measurement of BMD between 2011 and 2013 were included in this study if biplanar X-rays were available and if the patient did not have any medical condition influencing lumbar lordosis or BMD (e.g. fractures). Lumbar lordosis L1–S1 of the remaining 69 patients was measured on the lateral X-ray and was correlated to the lumbar and femoral BMD. Results: There was a significant negative correlation between lumbar lordosis and lumbar BMD (R=-0.447, p<0.001) even when taking into account potential confounding factors such as age, gender, BMI, and spondylotic changes. The correlation was strongest in the lumbar apex (L3, R=-0.458, p<0.001). We did not find a significant correlation between lumbar lordosis and femoral BMD (R=- 0.207, p=0.142). Conclusion: We found a statistically significant negative correlation between lumbar lordosis and lumbar BMD. As the correlation was strongest in the lumbar apex and as we found no significant correlation between lumbar lordosis and femoral BMD, increased lumbar lordosis might be considered to be the cause and not the result of low lumbar BMD. Thus, when assessing the risk of osteoporotic vertebral fractures in patients with hyperlordosis the possibility of low lumbar BMD especially at the lumbar apex should be considered.

Author(s): Woelfle Roos JV,Goldhahn I,, Weckbach SReichel H and Lattig F

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