CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Extended report

Prevalence of radiographic lumbar spondylosis and its association with low back pain in elderly subjects of population-based cohorts: the ROAD study

S Muraki¹, H Oka¹, T Akune¹, A Mabuchi¹, Y En-yo³, M Yoshida³, A Saika³, T Suzuki⁴, H Yoshida⁴, H Ishibashi⁴, S Yamamoto⁴, K Nakamura², H Kawaguchi², N Yoshimura¹

¹ 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Tokyo, Japan
² Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
³ Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
⁴ Sensory & Motor System Medicine, Faculty of Medicine, University of Tokyo, Tokyo, Japan

^{Correspondence to} Dr H Kawaguchi, Sensory & Motor System Medicine, Faculty of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo 113-8655, Japan; kawaguchi-ort{at}h.u-tokyo.ac.jp

Objectives: Although lumbar spondylosis is a major cause of low back pain and disability in elderly people, few epidemiological studies have been performed. The prevalence of radiographic lumbar spondylosis was investigated in a large-scale population study and the association with low back pain was examined.

Methods: From a nationwide cohort study (Research on Osteoarthritis Against Disability; ROAD), 2288 participants aged 60 years (818 men and 1470 women) living in urban, mountainous and coastal communities were analysed. The radiographic severity at lumbar intervertebral levels from L1/2 to L5/S was determined by Kellgren/Lawrence (KL) grading.

Results: In the overall population the prevalence of radiographic spondylosis with KL2 and 3 at the severest intervertebral level was 75.8% and 50.4%, respectively, and that of low back pain was 28.8%. Although KL2 spondylosis was more prevalent in men, KL3 spondylosis and low back pain were more prevalent in women. Age and body mass index were risk factors for both KL 2 and KL3 spondylosis. Although KL = 2 spondylosis was not significantly associated with low back pain compared with KL = 0 or 1, KL3 spondylosis was related to the pain only in women.

Conclusions: This cross-sectional study in a large population revealed a high prevalence of radiographic lumbar spondylosis in elderly subjects. Gender seems to be distinctly associated with KL2 and KL3 lumbar spondylosis, and disc space narrowing with or without osteophytosis in women may be a risk factor for low back pain.

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