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

## TL;DR

A 10-year study found no link between bone mineral density and the development of high-intensity back pain or disability in men.

## Contribution

This study provides longitudinal evidence in community-based men that BMD is not associated with incident back pain or disability.

## Key findings

- No association was found between BMD at any site and incident high-intensity back pain or disability.
- 37 men developed high-intensity pain or disability over 10 years, but this was not linked to BMD.
- The findings challenge the belief that low BMD causes back pain in the absence of fractures.

## Abstract

Although patients believe that osteoporosis is a painful condition, health professionals assume it is painless unless a fracture occurs. The association between 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 (occurring between 2006–2010) (considered the baseline for the current study) were followed for 10 years (reassessed between 2016–2021). Back pain and disability were assessed using the Graded Chronic Pain Scale at both time points. At baseline, DXA 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. A total of 679 participants had no to low-intensity pain and/or no to low disability at baseline. A total of 441 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.