Prevalence of radiographic lumbar spondylosis and its association with low back pain in elderly subjects of population-based cohorts: the ROAD study

Objectives: Although lumbar spondylosis is a major cause of low back pain and disability in the elderly, few epidemiologic studies have been performed. We investigated the prevalence of radiographic lumbar spondylosis using a large-scale population, and examined the association with low back pain. Methods: From a nationwide cohort study ROAD (Research on Osteoarthritis Against Disability), 2,288 participants (≥60 years; 818 men and 1,470 women) living in urban, mountainous and seacoast communities were analyzed. The radiographic severity at lumbar intervertebral levels from L1/2 to L5/S was determined by the Kellgren/Lawrence (KL) grading. Results: In the overall population, prevalence of radiographic spondylosis with KL≥2 and ≥3 at the severest intervertebral level was 75.8 and 50.4%, respectively, and that of low back pain was 28.8%. Although the KL≥2 spondylosis was more prevalent in men, the KL≥2 spondylosis and low back pain were more prevalent in women. Age and body mass index were risk factors for both KL≥2 and KL≥3 spondylosis. Although KL=2 spondylosis was not significantly associated with low back pain compared to KL=0 or 1, KL≥3 spondylosis was related to the pain only in women. Conclusions: The present cross-sectional study using a large population revealed a high prevalence of radiographic lumbar spondylosis in the elderly. Gender seems to be distinctly associated with KL≥2 and KL≥3 lumbar spondylosis, and disc space narrowing with or without osteophytosis in women may be a risk factor for low back pain.