Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Nydalen, P.O. Box 4956, N-0424, Oslo, Norway.
Department of Mathematics, University of Bergen, Bergen, Norway.
BMC Musculoskelet Disord. 2023 Jan 31;24(1):84. doi: 10.1186/s12891-023-06184-5.
There are indications that use of menopausal hormone therapy (MHT) and oral contraceptives (OC) increases the risk of low back pain (LBP), with higher oestrogen levels involved in the underlying mechanisms. The purpose of the present study was to investigate associations between use of systemic MHT or OC and risk of chronic LBP in a large population-based data set.
Data were obtained from two surveys in the Trøndelag Health Study in Norway, HUNT2 (1995-1997) and HUNT3 (2006-2008). A cross-sectional study of association between use of systemic MHT and prevalence of chronic LBP comprised 12,974 women aged 40-69 years in HUNT2, with 4007 women reporting chronic LBP. A cohort study involving MHT comprised 6007 women without chronic LBP at baseline in HUNT2, and after 11 years 1245 women reported chronic LBP at follow-up in HUNT3. The cross-sectional study of association with use of OC included 23,593 women aged 20-69 years in HUNT2, with 6085 women reporting chronic LBP. The corresponding cohort study included 10,586 women without chronic LBP at baseline in HUNT2, of whom 2084 women reported chronic LBP in HUNT3. Risk of chronic LBP was examined in both study designs in generalised linear models with adjustment for potential confounders.
In the cohort study, current users of systemic MHT at baseline showed a greater risk of chronic LBP (relative risk (RR) 1.30; 95% CI: 1.14-1.49; compared with never users). The risk increased according to duration of MHT use (P for linear trend = 0.003). Known users of systemic MHT based exclusively on oestrogen experienced the highest risk (RR 1.49; 95% CI: 1.16-1.91), but an increased risk was also seen among known users of oestrogen-progestin combination MHT (RR 1.35; 95% CI: 1.16-1.57). A slight increase in risk of chronic LBP was found in the cohort study among former users of OC (RR 1.17; 95% CI: 1.06-1.30; compared with never users).
Long-lasting use of systemic MHT, in particular therapy based on oestrogen only, is associated with greater risk of chronic LBP. Having been a user of OC most likely entails a minor increase in risk.
有迹象表明，使用更年期激素疗法（MHT）和口服避孕药（OC）会增加腰痛（LBP）的风险，其中涉及更高的雌激素水平是潜在机制之一。本研究的目的是在一个大型基于人群的数据集中调查全身 MHT 或 OC 的使用与慢性 LBP 风险之间的关联。
数据来自挪威特隆赫姆健康研究中的两项调查，HUNT2（1995-1997 年）和 HUNT3（2006-2008 年）。一项关于使用全身 MHT 与慢性 LBP 患病率之间关联的横断面研究包括了 HUNT2 中年龄在 40-69 岁的 12974 名女性，其中 4007 名女性报告患有慢性 LBP。一项涉及 MHT 的队列研究包括了 HUNT2 中基线时没有慢性 LBP 的 6007 名女性，11 年后，在 HUNT3 中有 1245 名女性报告患有慢性 LBP。与 OC 使用相关的横断面研究包括了 HUNT2 中年龄在 20-69 岁的 23593 名女性，其中 6085 名女性报告患有慢性 LBP。相应的队列研究包括了 HUNT2 中基线时没有慢性 LBP 的 10586 名女性，其中 2084 名女性在 HUNT3 中报告患有慢性 LBP。在这两项研究设计中，使用广义线性模型检查慢性 LBP 的风险，同时调整了潜在混杂因素的影响。
在队列研究中，基线时当前使用全身 MHT 的女性患慢性 LBP 的风险更高（相对风险（RR）为 1.30；95%置信区间（CI）：1.14-1.49；与从未使用者相比）。MHT 使用时间的长短与风险呈正相关（P 值趋势检验=0.003）。仅基于雌激素的已知全身 MHT 用户风险最高（RR 1.49；95%CI：1.16-1.91），但已知使用雌孕激素联合 MHT 的用户也存在风险增加（RR 1.35；95%CI：1.16-1.57）。在队列研究中，OC 的既往使用者中发现慢性 LBP 的风险略有增加（RR 1.17；95%CI：1.06-1.30；与从未使用者相比）。
长期使用全身 MHT，特别是基于雌激素的治疗，与慢性 LBP 的风险增加有关。OC 的使用者可能会使风险略有增加。
