The effect of obesity, diabetes, and epidural steroid injection on regional volumetric bone mineral density measured by
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ORIGINAL ARTICLE
The effect of obesity, diabetes, and epidural steroid injection on regional volumetric bone mineral density measured by quantitative computed tomography in the lumbosacral spine Ichiro Okano1,2 · Stephan N. Salzmann1 · Conor Jones1 · Marie‑Jacqueline Reisener1 · Courtney Ortiz Miller1 · Toshiyuki Shirahata1,2 · Jennifer Shue1 · John A. Carrino3 · Andrew A. Sama1 · Frank P. Cammisa1 · Federico P. Girardi1 · Alexander P. Hughes1 Received: 18 March 2020 / Revised: 25 August 2020 / Accepted: 20 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose High body mass index (BMI) is positively correlated with bone mineral density (BMD) in healthy adults; however, the effect of BMI on regional segmental BMDs in the axial skeleton is unclear. In addition, obese patients often have glucose intolerance and patients with lumbar spine pathology commonly have a history of epidural steroid injections (ESIs). The purpose of this study is to evaluate the effect of these patient factors on regional differences in BMD measured by quantitative computed tomography (QCT) in a lumbar fusion patient cohort. Methods The data were obtained from a database comprised of clinical and preoperative CT data from 296 patients who underwent primary posterior lumbar spinal fusion from 2014 to 2017. QCT-vBMDs of L1 to L5, S1 body, and sacral alae were measured. Multivariate linear regression analyses were performed with setting vBMDs as the response variables. As explanatory variables, age, sex, race, current smoking, categorized BMI, diabetes, and ESI were chosen a priori. Results A total of 260 patients were included in the final analysis. Multivariate analyses demonstrated that obese and morbidly obese patients had significantly higher vBMD in the sacral alae (SA). Diabetes showed independent positive associations with vBMDs in L1, L2, and the SA. Additionally, patients with an ESI history demonstrated significantly lower vBMD in the SA. Conclusions Our results demonstrate that obesity, diabetes, and epidural steroids affected vBMD differently by lumbosacral spine region. The vBMD of the SA appeared to be more sensitive to various patient factors than other lumbar regions. Keywords Bone mineral density · Quantitative computed tomography · Diabetes · Obesity · Epidural steroid injection
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-020-06610-5) contains supplementary material, which is available to authorized users. * Alexander P. Hughes [email protected] 1
Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
2
Department of Orthopaedic Surgery, Showa University School of Medicine, 1‑5‑8 Hatanodai, Shinagawa‑ku, Tokyo, Japan
3
Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
High body mass index (BMI) is associated with a higher bone mineral density (BMD) in healthy individuals and a lower frac
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