Central adiposity is associated with the severity and multiligamentous involvement of ossification of the posterior longitudinal ligament.
5 affiliations
- 1Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
- 2Spine Center, Hakodate Central General Hospital, Hakodate 040-8585, Japan.
- 3Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan.
- 4Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo 060-8648, Japan.
- 5Division of Diabetes and Endocrinology, Department of Medicine, NTT Sapporo Medical Center, Sapporo 060-0062, Japan.
Abstract
Ossification of the posterior longitudinal ligament (OPLL) is increasingly recognized as a metabolic ossification phenotype characterized by obesity-related abnormalities, particularly visceral adiposity. Although visceral fat has been implicated in the development of OPLL, its relationship with ossification severity and multiligamentous involvement remains unclear. This study aimed to examine whether anthropometric indices reflecting central adiposity show consistent associations with the burden of spinal ligament ossification. We retrospectively analyzed 252 individuals, including 163 patients with OPLL and 89 controls. Anthropometric indices-BMI and body roundness index (BRI)-were evaluated alongside CT-based measurements of visceral and subcutaneous fat areas. Ossification severity was quantified using a validated CT-based ossification index encompassing OPLL, ossification of the ligamentum flavum (OLF), ossification of the anterior longitudinal ligament (OALL), and ossification of the supra/interspinous ligaments (OSIL). Logistic regression, spline modeling, and sex-stratified analyses were performed. Patients with OPLL, particularly those with diffuse-type disease, exhibited significantly greater visceral adiposity and higher BMI and BRI values than controls. Both BMI and BRI were associated with the presence of diffuse OPLL, whereas their associations with localized OPLL were weaker. Nonlinear analyses showed that BMI was associated with ossification severity mainly within the lower BMI range, whereas BRI demonstrated generally linear associations across multiple ligamentous sites. These patterns were more evident in females. These findings suggest that anthropometric indices reflecting central adiposity may provide complementary information when evaluating the extent of spinal ligament ossification. While CT-derived visceral fat remains the direct measure of abdominal adiposity, indices, such as BRI, may offer additional context for understanding metabolic features associated with ossification burden in OPLL.
Related
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- Posterior circumferential decompression for multilevel thoracic ossification of the posterior longitudinal ligament: a case report and literature review.
- Postoperative ossification progression after decompression for thoracic ossification of the ligamentum flavum: associated factors identified by serial CT analysis.
- Association Between Salt Intake Habits and Vasomotor Symptoms According to Adiposity Among Middle-Aged Korean Women: A Longitudinal Cohort Study
- Age-related changes in adiposity and cardiometabolic disease risk: a longitudinal and prospective study in the UK Biobank
BibTeX
@article{xue2026central,
title = {{Central adiposity is associated with the severity and multiligamentous involvement of ossification of the posterior longitudinal ligament.}},
author = {Huohuo Xue and Tsutomu Endo and Yoshinao Koike and Ryo Fujita and Akinobu Nakamura and Kyu Yong Cho and Yuki Oe and M Alaa Terkawi and Masahiro Kanayama and Katsuhisa Yamada and Ken Kadoya and Hideki Sudo and Misaki Ishii and Norimasa Iwasaki},
journal = {JBMR plus},
year = {2026},
month = oct,
doi = {10.1093/jbmrpl/ziag165},
url = {https://europepmc.org/article/MED/42968899},
note = {CC BY},
}
RIS
TY - JOUR
TI - Central adiposity is associated with the severity and multiligamentous involvement of ossification of the posterior longitudinal ligament.
AU - Huohuo Xue
AU - Tsutomu Endo
AU - Yoshinao Koike
AU - Ryo Fujita
AU - Akinobu Nakamura
AU - Kyu Yong Cho
AU - Yuki Oe
AU - M Alaa Terkawi
AU - Masahiro Kanayama
AU - Katsuhisa Yamada
AU - Ken Kadoya
AU - Hideki Sudo
AU - Misaki Ishii
AU - Norimasa Iwasaki
PY - 2026
DA - 2026/10/13
JO - JBMR plus
DO - 10.1093/jbmrpl/ziag165
UR - https://europepmc.org/article/MED/42968899
AB - Ossification of the posterior longitudinal ligament (OPLL) is increasingly recognized as a metabolic ossification phenotype characterized by obesity-related abnormalities, particularly visceral adiposity. Although visceral fat has been implicated in the development of OPLL, its relationship with ossification severity and multiligamentous involvement remains unclear. This study aimed to examine whether anthropometric indices reflecting central adiposity show consistent associations with the burden of spinal ligament ossification. We retrospectively analyzed 252 individuals, including 163 patients with OPLL and 89 controls. Anthropometric indices-BMI and body roundness index (BRI)-were evaluated alongside CT-based measurements of visceral and subcutaneous fat areas. Ossification severity was quantified using a validated CT-based ossification index encompassing OPLL, ossification of the ligamentum flavum (OLF), ossification of the anterior longitudinal ligament (OALL), and ossification of the supra/interspinous ligaments (OSIL). Logistic regression, spline modeling, and sex-stratified analyses were performed. Patients with OPLL, particularly those with diffuse-type disease, exhibited significantly greater visceral adiposity and higher BMI and BRI values than controls. Both BMI and BRI were associated with the presence of diffuse OPLL, whereas their associations with localized OPLL were weaker. Nonlinear analyses showed that BMI was associated with ossification severity mainly within the lower BMI range, whereas BRI demonstrated generally linear associations across multiple ligamentous sites. These patterns were more evident in females. These findings suggest that anthropometric indices reflecting central adiposity may provide complementary information when evaluating the extent of spinal ligament ossification. While CT-derived visceral fat remains the direct measure of abdominal adiposity, indices, such as BRI, may offer additional context for understanding metabolic features associated with ossification burden in OPLL.
SN - 2473-4039
ER -