Bone health should be investigated as a cause of chronic back pain, say the authors of a review that argues that bone health and back pain have a shared genetic and environmental basis.
"Bone health and back pain are two important and likely correlated aspects of musculoskeletal health across the life span," write John Wark (University of Melbourne, Victoria, Australia) and co-workers.
"An association between bone health and back pain is plausible given the environmental and genetic correlates which are common to both," the authors reason in the journal Osteoporosis International.
To validate this proposed link, Wark and team reviewed four major scientific literature databases.
They confirmed a link between back pain and bone health and concluded that this is largely because patients do less physical activity after back pain develops.
In addition to avoiding exercise, individuals with severe back pain "tend to stiffen the trunk and limit normal movement at the intervertebral joints."
This is an "altered neuromuscular strategy that decreases the opportunity for the normal physiologic stresses necessary for maintenance of skeletal integrity, to be transferred through the vertebrae," the investigators explain.
They also identified obesity and spine structure as combined environmental and genetic influences on both back pain and impaired bone health.
The authors note that few studies have examined links between chronic back pain and bone health in young individuals, but say that "the negative effects of childhood skeletal trauma and obesity on bone and spinal health provide indirect evidence for an association."
Wark and team cite the need for prospective studies to clarify the influence of back pain on bone health at different ages and also suggest that research efforts "should be directed towards medical imaging, for example, optimizing methods for the measurement of sub-regional vertebral bone mineral density and investigating Modic changes more closely."