Article Text

Extended report
Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK Twin Spine Study
  1. Gregory Livshits1,2,
  2. Maria Popham1,
  3. Ida Malkin2,
  4. Philip N Sambrook3,
  5. Alex J MacGregor1,4,
  6. Timothy Spector1,
  7. Frances M K Williams1
  1. 1Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
  2. 2Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, Israel
  3. 3Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
  4. 4School of Medicine, University of East Anglia, Norwich, UK
  1. Correspondence toDr Frances M K Williams, Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, London SE1 7EH, UK; frances.williams{at}


Objective Low back pain (LBP) is a common musculoskeletal disorder, but it is still unclear which individuals develop it. The authors examined the contribution of genetic factors, lumbar disc degeneration (LDD) and other risk factors in a female sample of the general population.

Material and Methods A cross-sectional study was conducted among 2256 women (371 and 698 monozygotic and dizygotic twin pairs and 29 sibling pairs and 60 singletons) with a mean age of 50 years (18–84). A self-reported validated questionnaire was used to collect back pain data. Risk factors including body weight, smoking, occupation, physical exercise and MRI assessed LDD were measured. Data analysis included logistic regression and variance decomposition.

Results The major factors associated with LBP included genetic background, with OR approximately 6 if the monozygotic co-twin had LBP, or 2.2 if she was a dizygotic co-twin. In addition, LDD and overweight were highly significantly (p<0.001) associated with non-specific LBP. The single most important risk factor was the amount of LDD. After adjustment for other risk factors, the individuals who exhibited advanced LDD (90% vs 10%) had 3.2 higher odds of manifesting LBP. The data also showed a significant (p<0.001) genetic correlation between the LBP and LDD measurements, suggesting that approximately 11–13% of the genetic effects are shared by LDD and LBP.

Conclusions The main risk factors for reported episodes of severe and disabling LBP in UK women include the degree of LDD as assessed by MRI, being overweight and genetic heritability.

This paper is freely available online under the BMJ Journals unlocked scheme, see

Statistics from

Supplementary materials

  • Web Only Data

    Files in this Data Supplement:


  • Funding The Wellcome Trust, the Arthritis Research Campaign, Israeli Ministry of Health chief scientist.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the St Thomas' Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.