CORRELATION BETWEEN DEGENERATIVE LUMBER SPINE DISEASES (SPONDYLOLISTHESIS, RETROLISTHESIS AND SPINAL STENOSIS) WITH BONE MINERAL DENSITY AND TRABECULAR BONE SCORE: CASE-CONTROL STUDY

Abstract

Background: Degenerative lumbar spine diseases are among the leading causes of low back pain and disability worldwide. Bone mineral density and trabecular bone score are important indicators of bone quantity and microarchitecture, respectively. However, the correlation between individual degenerative lumbar spine diseases and these bone health parameters remains controversial because previous studies have reported inconsistent findings. Objectives: To investigate the correlation between lumber spinal degenerative diseases with bone mineral density and trabecular bone score, specifically degenerative spondylolisthesis, retrolisthesis, and lumbar spinal stenosis. Patients and methods: A hospital-based case-control study was conducted at Al-Basrah Teaching Hospital, Basrah, Iraq, between June 2025 to June 2026. Demographic and clinical data were collected, and lumbar spine radiographs, computed tomography, and magnetic resonance imaging were used to identify degenerative spinal disorders. Bone mineral density and trabecular bone score were assessed using dual-energy X-ray absorptiometry. Statistical analysis was performed using the Statistical Package for the Social Sciences version 31, and a probability value of less than 0.05 was considered statistically significant. Results: A total of 781 participants were included, including 521 patients with degenerative lumbar spine diseases and 260 healthy controls. The majority of participants were females 649 (83.1%), while males accounted for 132 (16.9%). Lumbar spinal stenosis was the most common degenerative disorder, affecting 289 (37.0%) participants, followed by degenerative spondylolisthesis 223 (28.6%), and retrolisthesis 9 (1.15%). The L4–L5 level was the most frequently affected spinal segment, occurring in 258 (33.0%) cases. Degenerative spondylolisthesis demonstrated significant negative correlations with both bone mineral density (r = −0.336, P <0.001) and trabecular bone score (r = −0.385, P <0.001) and was significantly associated with BMD and TBS categories. Lumbar spinal stenosis showed a significant negative correlation with trabecular bone score (r = −0.230, P = 0.009) and significant associations with both BMD and TBS categories. Retrolisthesis showed no significant correlations or associations with either bone mineral density or trabecular bone score. There was no significant association between the affected spinal level and BMD (P = 0.220) or TBS (P = 0.378). Conclusions: Degenerative spondylolisthesis demonstrated the strongest relationship with bone health, showing significant correlations and associations with both bone mineral density and trabecular bone score. Lumbar spinal stenosis showed a weaker but significant relationship with bone health, including significant associations with both bone mineral density and trabecular bone score categories and a significant negative correlation with trabecular bone score, whereas retrolisthesis was not significantly related to either parameter. Trabecular bone score provided complementary information to bone mineral density in assessing bone quality in patients with degenerative lumbar spine diseases. The reasons behind this study are that osteoporosis and osteopenia can contribute to chronic back pain.