Bone mineral density is not associated with incident high-intensity back pain: a 10-year cohort study in men

Abstract Although patients believe osteoporosis is a painful condition, health professionals assume it is painless unless a fracture occurs. The association between bone mineral density (BMD) and back-pain has not been examined longitudinally in community-based adults in an unbiased population, using gold standard measures. This study aimed to examine the association between BMD and incident high-intensity back pain and/or high-disability over 10 years in Australian men without high-intensity symptoms at baseline. Men with no high-intensity back pain and/or high-disability attending the Geelong Osteoporosis Study at the 5-year visit (2006-2010) (considered the baseline for the current study), were followed for 10 years (2016-2021). Back pain and disability were assessed using the Graded Chronic Pain Scale at both time points. At baseline, dual energy X-ray absorptiometry was used to measure lumbar spine and total hip BMD and spinal artefacts. The relationships between BMD and incident high-intensity pain and/or high-disability at follow-up were examined using binary logistic regression, adjusted for age, body mass index, depression, education, smoking, mobility and spinal artefacts. Six hundred and seventy-nine participants had no to low-intensity pain and/or no to low-disability at baseline. Four hundred and forty-one attended follow-up, providing back pain and disability data. Thirty-seven men developed high-intensity pain and/or high-disability. No association of BMD at any site was seen with incident high-intensity pain and/or high-disability. BMD was not associated with incident high-intensity pain or disability in community-based men. These data provide evidence to dispel the erroneous community-held belief that low BMD is related to back-pain and disability.