Processed Foods Bad for the Bones; Traditional Back Pain Red Flags Not Predictive; Mom’s Low Vitamin D = Kyphosis Risk in Offspring

Processed Foods Bad for the Bones

Making a steady diet out of processed foods can lower bone quality and contribute to back pain and osteoporosis.

The new study from the Icahn School of Medicine at Mount Sinai and Rensselaer Polytechnic Institute, “Dietary Advanced Glycation End Products Have Sex‐ and Age‐Dependent Effects on Vertebral Bone Microstructure and Mechanical Function in Mice,” appeared in the November 21, 2017 edition of the Journal of Bone and Mineral Research.

Svenja Illien‐Jünger, Ph.D., with the Leni and Peter W. May Department of Orthopaedics at Mount Sinai and co-author on the research, told OTW, “Typical ‘Western diet’ foods are often processed (especially fast food which typically has been heat treated, pasteurized, dried, smoked or fried) and often contain high amounts of so-called advanced glycation end products (AGEs).”

“Diets high in AGEs have been linked to weight gain and diabetes. In this study we examined if diet also affects vertebral bone health by assessing the extent to which changes in diet could decrease vertebral fractures and prevent bone loss as people age.”

The authors wrote, “Female and male mice were fed low‐AGE (L‐AGE) or high‐AGE (H‐AGE) isocaloric diets for 6 and 18 months and multiple measurements of bone structure and function were taken.”

“AGE levels in serum and cortical vertebrae were increased only for 6‐month‐old H‐AGE female mice while blood glucose and body weight remained normal for all animals. When fed an H‐AGE diet, 6‐month‐old female mice had inferior vertebral trabecular structure with decreased bone mineral density (BMD) and bone volume fraction.”

“Biomechanical testing and analytical modeling further showed functional deterioration in 6‐month‐old H‐AGE females with reduced shear and compression moduli, and maximum load to failure. At 18 months, H‐AGE mice of both sexes had significant but small decreases in cortical BMD and thickness, yet functional biomechanical behaviors were not distinguishable from other aging changes.”

“In this study we compared the effect of diet on female and male mice in two age groups ‘young’ (6 month) and “old” (18 month). We fed mice two diets, which only differed in the amount of AGEs (AGEs were increased by heat treating). Half of the mice were fed a diet high in AGEs while the other half had a diet lower in AGEs. The effects of diets on vertebral bones were analyzed at 6 and 18 months.”

“This is the first study that shows that diets high AGEs can directly alter vertebral bone quality, with bone loss and inferior biomechanical properties. Importantly, diets had a stronger influence on female than on male mice. Our study emphasizes the importance of nutrition in promoting spinal health and susceptibility to injury.”

“Our study suggests that chronic consumption of processed foods negatively impacts bone quality with age, and potentially could cause back pain and spine disease including osteoporosis. Our results could serve as a warning to young women to be especially careful of what they eat, as specific foods could accelerate the aging of their bones and contribute to debilitating back problems in the future.”

“We previously showed that diabetes, which also led to AGE accumulation in the spine, was associated with vertebral pathology and intervertebral disc degeneration.”

“We found that these pathologies were partially mitigated by oral administration of FDA approved anti-AGE and anti-inflammatory drugs. While our study suggested that drug treatment is possible, more studies are required to identify the underlying mechanisms, so that specific therapeutics can be developed. Therefore, at this point we recommend educating patients that improved diet can be used as preventative treatments for spinal pathologies.”

Traditional Back Pain Red Flags Not Predictive

Clinicians should use discretion when using the familiar “red flag” questions as screening tools for low back pain, says new research from Emory University School of Medicine and Hospital for Special Surgery (HSS).

“Red Flags for Low Back Pain Are Not Always Really Red: A Prospective Evaluation of the Clinical Utility of Commonly Used Screening Questions for Low Back Pain,” was published in the March 7, 2018 edition of The Journal of Bone and Joint Surgery.

Scott Boden, M.D., orthopedic surgeon at Emory University, and co-author on the study told OTW, “We have a large spine multidisciplinary spine center at Emory and it has a contact center that receives and schedules thousands of new patients each month.”

“We have a sophisticated triage system that for many years included a version of the ‘red flag’ questions. In addition, we asked the patients those same questions in more detail as part of their initial new patient history because that was the doctrine we were all taught in medical school and beyond.”

“We had observed a substantial number of false positive answers to the ‘red flag’ questions and wanted to explore using a large dataset whether they added value to the patient history or not.”

“The design used patient derived answers to the red flag questions collected over many years on every new patient that filled out a computerized tablet-based questionnaire on their first office visit.”

“The classic ‘red flags’ were not very predictive of serious pathology as they were intended to identify.”

“Specific individual red flags and combinations of red flags were associated with an increased probability of underlying serious spinal pathology, e.g., recent trauma and an age of >50 years were associated with vertebral fracture.”

“The presence or absence of other red flags, such as night pain, was unrelated to any particular diagnosis. For instance, for patients with no recent history of infection and no fever, chills, or sweating, the presence of night pain was a false-positive finding for infection >96% of the time.”

“In general, the absence of red flag responses did not meaningfully decrease the likelihood of a red flag diagnosis; 64% of patients with spinal malignancy had no associated red flags. While a positive response to a red flag question may indicate the presence of serious disease, a negative response to 1 or 2 red flag questions does not meaningfully decrease the likelihood of a red flag diagnosis.”

Mom’s Low Vitamin D = Kyphosis Risk in Offspring

Are pregnant women getting enough vitamin D to trickle down to their littles ones…and to event prevent future spine problems?

New research, “Maternal Diets Deficient in Vitamin D Increase the Risk of Kyphosis in Offspring: A Novel Kyphotic Porcine Model,” appears in the March 7, 2018 edition of The Journal of Bone and Joint Surgery which says ‘yes’.

Matthew Halanski, M.D., orthopedic surgeon with the University of Wisconsin-Madison (UW) and co-author wrote, “…169 pigs which were exposed to 1 of 3 dietary vitamin-D levels from conception through the entire lactation period were fed 1 of 4 nursery diets supplying different levels of vitamin D, calcium, and phosphorus.”

“When the animals were 13 weeks of age, upright lateral spinal radiography was performed with use of a custom porcine lift and sagittal Cobb angles were measured in triplicate to determine the degree of kyphosis in each pig. The spines of 16 pigs were assessed at 9, 13, and 17 weeks of age with radiography and at 17 weeks with computed tomography (CT), magnetic resonance imaging (MRI), histology, and bone-density testing.”

“Dr. Tom Crenshaw in the UW Animal Science department at the UW Swine Research and Teaching Center, serendipitously came across this discovery. The finding has been reproduced several times now.”

“We have been interested in these findings on the bone development and nutritional side of the project as well as the potential human clinical applications of these findings. We recognized that this could be a very useful large animal spinal deformity model that could be created without surgery—something that has been lacking in spinal deformity research.”

“The collaboration between animal sciences and medical sciences is quite unique. Often the high cost of large animal models in biomedical research limits study numbers to only a handful of animals. As these animals are part of a commercial swine production, this allowed a much larger number of animals to be studied than typical.”

“I think the two biggest results were that 1) maternal and early diet may make individuals more susceptible to later spinal deformities, 2) We may now have a non-operative large animal spinal deformity model to use for future studies to evaluate novel therapies.”

“Ensuring adequate maternal and newborn diet especially vitamin D may be important in decreasing the risk of future spinal deformities. We may have found one modifiable risk factor for the development of spinal deformities and we may have a spinal deformity model for future research.”