Association between bone mineral density and lower back pain in the general United States population using the NHANES of 1999-2004

Zhou, Yang; Li, Chi; Dai, Wangying; Teng, Honglin; Wang, Yu; Zhu, Minyu; Wang, Jing

doi:10.3389/fsurg.2025.1535614

ORIGINAL RESEARCH article

Front. Surg.

Sec. Orthopedic Surgery

Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1535614

This article is part of the Research Topic Minimally Invasive Treatments for Lumbar Spine Disorders View all 6 articles

Association between bone mineral density and lower back pain in the general United States population using the NHANES of 1999-2004

Provisionally accepted

Yang Zhou ^* Chi Li

Chi Li

Wangying Dai

Honglin Teng Yu Wang

Yu Wang

Minyu Zhu

Jing Wang

First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

The final, formatted version of the article will be published soon.

Lower back pain (LBP) is a prevalent health issue that has substantial effects on individuals and society. However, the association between bone mineral density (BMD) and LBP remains controversial. In this study we aimed to ascertain whether a relationship exists between BMD and LBP in the United States population.Data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2004 were analyzed using a cross-sectional approach. BMD and LBP were assessed using multivariate logistic regression, smoothing curves, and generalized additive models. Subgroup analyses were also performed to ensure data stability and mitigate confounding factors.In this population-based study, the data of 107,570 adults were analyzed (mean age: 47.13 ± 18.38 years) and 36.74% of them had LBP. After controlling for all covariates, a positive correlation was established between BMD and LBP [odds ratio (OR)=1.87, 95% confidence interval (CI)= (1.00, 3.50)]. The two-segment linear regression model revealed a U-shaped relationship between BMD and LBP with a 1.14 g/cm 2 inflection point. BMD values < 1.14 g/cm 2 were linked to a lower likelihood of experiencing LBP [OR=0.55, 95%CI= (0.45, 0.68)]. However, a BMD > 1.14 g/cm 2 increased the risk of LBP [OR=6.15, 95%CI= (4.51, 8.39)].BMP was significantly and positively correlated with LBP. A U-shaped relationship was observed between BMD and LBP, indicating that both insufficient and excessive BMD may increase the risk of LBP.

Keywords: Lower Back pain, bone mineral density, Osteoporosis, economic impact, U-shaped relationship

Received: 27 Nov 2024; Accepted: 18 Mar 2025.

Copyright: © 2025 Zhou, Li, Dai, Teng, Wang, Zhu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Yang Zhou, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

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