What are the risk factors for lumbar spine arthritis?

Risk Factors for Lumbar Spine Arthritis

Obesity is the single most consistent and strongest modifiable risk factor for developing lumbar spine arthritis, predicting both incident disease and progression across multiple structural phenotypes including disc space narrowing, facet joint osteoarthritis, and osteophyte formation. 1

Age-Related Risk

• Facet joint arthrosis is nearly universal with aging, affecting 57% of individuals aged 20-29 years, 82% of those 30-39 years, 93% of those 40-49 years, 97% of those 50-59 years, and 100% of individuals over 60 years old 2
• Evidence of arthritic changes begins early, with more than half of adults younger than 30 years already demonstrating facet joint changes 2
• The L4-L5 level shows the highest prevalence and severity of arthrosis compared to all other lumbar levels 2

Obesity and Body Mass Index

• Obesity demonstrates hazard ratios of 1.80 for disc space narrowing, 1.56 for spine osteoarthritis, 4.99 for facet joint osteoarthritis, and 1.87 for spondylolisthesis 1
• Obesity also predicts worsening of existing disc space narrowing (HR 1.51) 1
• In obese patients, severe intervertebral disc degeneration is significantly more common (73.5% vs 50.4%), particularly at the L4-L5 level (50% vs 27.4%) 3
• Obese patients show more severe fatty infiltration in paraspinal muscles at upper lumbar levels and more severe disc degeneration at lower lumbar levels, suggesting a cascading degenerative process 3

Sex Differences

• Men have significantly greater prevalence and degree of facet arthrosis than women at all lumbar levels 2
• However, obese women specifically show higher rates of Modic changes (vertebral endplate changes) compared to non-obese women (35.9% vs 16.4%) 3
• Women demonstrate more pronounced effects of obesity on paraspinal muscle quality and Modic changes 3

Biomechanical Factors

• More coronally oriented facet joints (≥32°) at the upper lumbar spine (L2/3 level) represent an individual anatomic risk factor for developing facet joint arthritis 4
• Mean facet joint orientation progresses from 30.4° at L2/3 to 47.3° at L5/S1, with the L2/3 cutoff of ≥32° being the critical threshold 4
• Daily activities involving repetitive axial loading and flexion stress on the lumbar spine, such as carrying heavy objects, are established risk factors for disc herniation 5

Associated Joint Disease

• Knee osteoarthritis predicts incident facet joint osteoarthritis (HR 4.18) 1
• Hip osteoarthritis predicts worsening of low back pain (HR 1.39) 1
• This suggests a systemic component to osteoarthritis affecting both appendicular and axial joints 1

Medical Comorbidities

• Children receiving systemic glucocorticoid therapy for inflammatory diseases (juvenile dermatomyositis, juvenile idiopathic arthritis, systemic lupus erythematosus) are at higher risk for vertebral body fractures 6
• Inflammatory conditions requiring prolonged corticosteroid use (≥3 months) increase vertebral fracture risk 6

Prior Injury History

• A prior episode of back pain suggests underlying disc pathology that may recur and progress to degenerative changes 5
• Previous back injury is a self-reported risk factor for progressive spine degeneration 1

Clinical Pitfalls to Avoid

• Do not assume lumbar spine arthritis is solely an age-related phenomenon—obesity is a stronger and modifiable predictor than age alone for disease incidence and progression 1
• Recognize that facet joint orientation ≥32° at L2/3 represents an anatomic predisposition that cannot be modified but should inform prognosis 4
• Approximately 40% of women aged 55 and 85% of those over 75 years will have spine osteoarthritis, which can spuriously elevate bone mineral density measurements on DXA scans and confound osteoporosis assessment 6