Thesis defence in the University of Oulu

Doctoral Candidate

Licenciate of Medicine Jyri Järvinen

Faculty and research unit

University of Oulu Graduate School, Faculty of Medicine, University of Oulu Graduate School, Medical Research Center Oulu

Field of study

Radiology

Date and time of the thesis defence

16.10.2020 12:00

Place of the thesis defence

Oulu University Hospital, lecture hall 7, Zoom link: https://oulu.zoom.us/j/66382607129?pwd=bll4K2x5Y29kVCtJaUNsUDZCOTZ3dz09

Topic of the dissertation

Lumbar degenerative Modic changes: Association between bone turnover and low back symptoms, and the effect of a zoledronic acid treatment intervention

Opponent

Docent Pekka Niemi, University of Turku

Custos

Professor Jaakko Niinimäki, University of Oulu

Lumbar degenerative Modic changes are associated with increased bone turnover and low back symptoms

Lumbar degenerative bone marrow changes, Modic changes (MC), are visible in the bone marrow adjacent to the degenerated intervertebral discs in magnetic resonance imaging (MRI). MC are categorized into three types: Type 1 (MC1) appears as inflamed bone marrow and is composed mainly of fibrovascular tissue proliferation, Type 2 (MC2) appears as fat and is composed of yellow fat replacement, and Type 3 (MC3) appears as dense bone and is composed of highly mineralized, sclerotic bone marrow.

This thesis investigated the associations of MC with bone turnover in bone scintigraphy and with prospective low back symptoms, and the treatment response of MC to a single intravenous infusion of zoledronic acid (ZA), an osteoporosis drug.

Bone scintigraphy is a method of nuclear imaging which shows active bone turnover as increased tracer uptake in the skeleton. Patients who had undergone lumbar MRI and bone scintigraphy within six months of each other in 2007–2008 were included in the study. Bone turnover was increased in the area of MC1 more often than in other MC types. This reflects the inflammatory nature of MC1 and is consistent with increased vascularity and bone turnover. Patients with MC and low back symptoms were followed for over a two-year period. MC1 was associated with pain intensity and disability, whereas the same correlation was not found for MC2.

In a randomized controlled trial, the effect of ZA on MC was compared with that of intravenous saline. MRI was examined at baseline and approximately 12 months after the infusion. A trend of MC1 converting to MC2, and a reduction in the volume of MC1 was noted as a result of ZA.

In conclusion, MC1 is more consistently associated with increased bone turnover and low back symptoms than other MC types. ZA may offer an alternative treatment for MC1. However, more research must be conducted to confirm the benefits of ZA.

Dissertation

Last updated: 12.10.2020