Hartvigsen Jan, Christensen Kaare, Frederiksen Henrik, Petersen Hans Christian
Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Spine (Phila Pa 1976). 2004 Apr 15;29(8):897-901; discussion 902. doi: 10.1097/00007632-200404150-00015.
Self-reported 1-month prevalence of back pain in older twins assessed at intake in a population-based longitudinal survey.
To determine the relative contribution of genetic and environmental factors to back pain in old age.
To date, genetic contributions to back pain in old age have not been assessed, to the authors' best knowledge.
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.
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.
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.
在一项基于人群的纵向调查中，对老年双胞胎入组时自我报告的1个月背痛患病率进行评估。
确定遗传和环境因素对老年背痛的相对影响。
据作者所知，迄今为止尚未评估遗传因素对老年背痛的影响。
1995年、1997年、1999年和2001年对丹麦70岁及以上双胞胎进行的一项全国性队列序贯人群调查中，入组时的访谈数据构成了本分析的基础。使用先证者一致率、比值比和背痛的四分相关系数来估计双胞胎相似性分析。通过双变量概率估计法估计遗传力（人群方差中可归因于遗传变异的比例），并针对已知的显著环境因素进行调整。在控制年龄、性别和遗传效应后，估计已知环境效应的比值比。
在男性和女性中，同卵双胞胎和异卵双胞胎在先证者一致率、比值比和四分相关系数方面存在适度且不显著的差异。在双变量概率估计中，发现目前或既往诊断为骨质疏松症、退行性关节疾病或腰椎间盘突出症会显著影响背痛风险。加性遗传效应约占男性报告背痛易感性的四分之一，而女性则无此效应。个体环境效应约占男性背痛发生率的75%，女性的100%。
加性遗传效应在老年男性背痛中起适度作用，但在女性中不起作用。目前或既往诊断为骨质疏松症、退行性关节疾病或腰椎间盘突出症与背痛密切相关，即使在控制遗传因素后也是如此。由于存在固有的方法学问题，对老年背痛遗传影响的这一估计可能较为保守。
