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. 1998 Feb;57(2):94–99. doi: 10.1136/ard.57.2.94

Allelic variation in the vitamin D receptor, lifestyle factors and lumbar spinal degenerative disease

G Jones 1, C White 1, P Sambrook 1, J Eisman 1
PMCID: PMC1752533  PMID: 9613338

Abstract

OBJECTIVE—To describe the relation between spinal degenerative disease, allelic variation in the vitamin D receptor gene, and lifestyle factors in a population-based association study.
METHODS—Random population-based sample of 110 men and 172 women over 60 years of age participating in the Dubbo Osteoporosis Epidemiology Study who had spinal radiographs (performed according to a standardised approach), assessment of lifestyle factors, bone densitometry as well as blood taken for genotyping.
RESULTS—Spinal degenerative disease of varying severity was common in this sample. Multivariate analysis of genetic and lifestyle factors simultaneously strengthened the statistical significance of each indicating the presence of additive gene environment interaction. Allelic variation in the vitamin D receptor gene was associated with severity of osteophytosis (adjusted OR "TT" v "tt" 0.41, 95% CI 0.17, 0.97), presence of disc narrowing (adjusted OR "TT" v "tt" 0.45, 95% CI 0.20, 0.99) and weakly with presence of osteophytosis (adjusted OR "TT" v "tt" 0.47, 95% CI 0.19, 1.16) but not with severity of disc narrowing (OR "TT" v "tt" 1.05, 95% CI 0.40, 2.72) or apophyseal arthritis (OR "TT" v "tt" 0.63, 95% CI 0.24, 1.59). Adjustment for femoral neck bone density did not change these findings suggesting that the association is not mediated through bone density. Presence and severity of spinal degenerative disease increased with age at all sites. Current smoking increased both the presence (adjusted OR 9.70, 95% CI 2.08, 45.1) and severity (adjusted OR 2.91, 95% CI 1.16, 9.03) of spinal osteophytosis with intermediate values for past smokers. Severity of osteophytosis was also independently associated with body mass index and quadriceps strength consistent with a contributory effect of physical loading.
CONCLUSIONS—In this elderly sample, both genetic and lifestyle factors were associated with the presence and severity of spinal degenerative disease. There were site specific differences in associations at the spine, which may be because of misclassification of disease status or may indicate possible environmental and genetic differences in the pathophysiology of spinal degenerative disease. Further studies are required to confirm these findings in different population samples and to further explore potential aetiological mechanisms particularly gene environment interaction.

 Keywords: lumbar spinal degenerative disease; lifestyle; genetic

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Figure 1  .

Figure 1  

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Allelic variation in the vitamin D receptor gene and spinal degenerative disease. For most categories there is a trend for decreasing presence and severity of spinal degenerative disease. However, this was not statistically significant at any site for the unadjusted data.

Figure 2  .

Figure 2  

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Smoking status and spinal osteophytosis. For both presence (A) and severity (B) of osteophytosis the proportion with osteophytosis is increased in smokers compared with non- smokers with past smokers having an intermediate value. Data are presented unadjusted for potential confounders and the p values represent the difference between each category compared with non-smokers after excluding the other category.

Selected References

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