Osteoporosis as an Independent Risk Factor for IVD Degeneration: A Case-Control and Imaging Cohort Study

Purpose To investigate the correlation between bone mineral density (BMD) and intervertebral disc (IVD) degeneration, assessing whether osteoporosis is an independent risk factor for IVD degeneration, and analyzing its impact on IVDs, endplates, and paravertebral muscles. Methods A case-control study was conducted involving 392 patients with lumbar disc herniation (LDH) and 170 healthy controls. Multivariable logistic regression was used to assess the association between BMD (T-score) and LDH. Subsequently, a retrospective imaging cohort study was performed. From the initial patient group, participants were stratified into an osteoporosis cohort (n = 76) and a non-osteoporosis cohort (n = 116) based on dual-energy X-ray absorptiometry results. To ensure comparability of imaging outcomes, the cohorts were constructed with an approximate matching design based on key epidemiological variables. Imaging parameters compared between the matched cohorts included Pfirrmann grade, endplate damage score, Modic changes, relative functional cross-sectional area (FrCSA) and fat infiltration rate of paravertebral muscles. Results Each 1.0 increase in T-score was associated with a 12.6% reduction in LDH risk (adjusted OR = 0.874, 95% CI: 0.775–0.986, p  = 0.028). The osteoporosis cohort exhibited more severe IVD degeneration (L1/2 to L4/5), higher endplate damage scores at all levels, reduced muscle FrCSA at L3/4, and significantly higher fat infiltration in the psoas major and erector spinae at nearly all levels, as well as in the multifidus at specific levels (all p  < 0.05 unless noted). Conclusions Osteoporosis is an independent risk factor for IVD degeneration and is associated with more severe disc degeneration, greater endplate damage, and structural/functional deterioration of paravertebral muscles. These findings suggest a multi-structural synergistic role of osteoporosis in IVD degeneration.