Genetic and environmental contributions to back pain in old age: a study of 2,108 danish twins aged 70 and older

Jan Hartvigsen, Kaare Christensen, Henrik Frederiksen, Hans Christian Petersen, Hans Christian Pedersen
Spine 2004 April 15, 29 (8): 897-901; discussion 902

STUDY DESIGN: Self-reported 1-month prevalence of back pain in older twins assessed at intake in a population-based longitudinal survey.

OBJECTIVES: To determine the relative contribution of genetic and environmental factors to back pain in old age.

SUMMARY OF BACKGROUND DATA: To date, genetic contributions to back pain in old age have not been assessed, to the authors' best knowledge.

METHODS: Interview data given at entry into a nationwide cohort-sequential population-based survey of Danish twins aged 70 years and older in 1995, 1997, 1999, and 2001 form the basis of this analysis. Analysis of twin similarity was estimated using probandwise concordance rates, odds ratios, and tetrachoric correlations for back pain. Heritability (proportion of the population variance attributable to genetic variation) was estimated by bivariate probit estimation and adjusted for known significant environmental factors. Odds ratios for known environmental effects were estimated after controlling for age, sex, and genetic effects.

RESULTS: Modest and nonsignificant differences between monozygotic and dizygotic twin pairs were found for probandwise concordance rates, odds ratios, and tet-rachoric correlations for both men and women. In the bivariate probit estimation, a current or previous diagnosis of osteoporosis, degenerative joint disease, or lumbar disc prolapse was found to significantly affect the risk of back pain. Additive genetic effects explained approximately one fourth of the liability to report back pain in men and none of the occurrence in women. Individual environmental effects were found to explain roughly 75% of the occurrence of back pain in men and 100% in women.

CONCLUSIONS: Additive genetic effects are modest contributors to back pain in older men but not in women. A current or previous medical diagnosis of osteoporosis, degenerative joint disease, or lumbar disc prolapse is-strongly associated with back pain, also when genetic factors are controlled for. Because of inherent methodologic issues, this estimate of the genetic influence on back pain in old age is probably conservative.

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