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Osteoporosis International

, Volume 15, Issue 9, pp 760–765 | Cite as

Back pain, disability, and radiographic vertebral fracture in European women: a prospective study

  • T. W. O’Neill
  • W. Cockerill
  • C. Matthis
  • H. H. Raspe
  • M. Lunt
  • C. Cooper
  • D. Banzer
  • J. B. Cannata
  • M. Naves
  • B. Felsch
  • D. Felsenberg
  • J. Janott
  • O. Johnell
  • J. A. Kanis
  • G. Kragl
  • A. Lopes Vaz
  • G. Lyritis
  • P. Masaryk
  • G. Poor
  • D. M. Reid
  • W. Reisinger
  • C. Scheidt-Nave
  • J. J. Stepan
  • C. J. Todd
  • A. D. Woolf
  • J. Reeve
  • A. J. Silman
Original Article

Abstract

Vertebral fractures are associated with back pain and disability. There are, however, few prospective data looking at back pain and disability following identification of radiographic vertebral fracture. The aim of this analysis was to determine the impact of radiographically identified vertebral fracture on the subsequent occurrence of back pain and disability. Women aged 50 years and over were recruited from population registers in 18 European centers for participation in the European Prospective Osteoporosis Study. Participants completed an interviewer-administered questionnaire which included questions about back pain in the past year and various activities of daily living, and they had lateral spine radiographs performed. Participants in these centers were followed prospectively and had repeat spine radiographs performed a mean of 3.7 years later. In addition they completed a questionnaire with the same baseline questions concerning back pain and activities of daily living. The presence of prevalent and incident vertebral fracture was defined using established morphometric criteria. The data were analyzed using logistic regression with back pain or disability (present or absent) at follow-up as the outcome variable with adjustment made for the baseline value of the variable. The study included 2,260 women, mean age 62.2 years. The mean time between baseline and follow-up survey was 5.0 years. Two hundred and forty participants had prevalent fractures at the baseline survey, and 85 developed incident fractures during follow-up. After adjustment for age, center, and the baseline level of disability, compared with those without baseline prevalent fracture, those with a prevalent fracture (odds ratio [OR]=1.4; 95% confidence interval [CI] 1.0 to 2.0) or an incident fracture (OR=1.7; 95% CI, 0.9 to 3.2) were more likely to report disability at follow-up, though the confidence intervals embraced unity. Those with both a prevalent and incident fracture, however, were significantly more likely to report disability at follow-up (OR=3.1; 95% CI, 1.4 to 7.0). After adjustment for age, center, and frequency of back pain at baseline, compared with those without baseline vertebral fracture, those with a prevalent fracture were no more likely to report back pain at follow-up (OR=1.2; 95%CI, 0.8 to 1.7). There was a small increased risk among those with a preexisting fracture who had sustained an incident fracture during follow-up (OR=1.6; 95%CI, 0.6 to 4.1) though the confidence intervals embraced unity. In conclusion, although there was no significant increase in the level of back pain an average of 5 years following identification of radiographic vertebral fracture, women who suffered a further fracture during follow-up experienced substantial levels of disability with impairment in key physical functions of independent living.

Keywords

Back pain Disability Prospective study Vertebral fracture 

Notes

Acknowledgements

The study was financially supported by a European Union concerted action grant under Biomed-1 (BMH1CT920182), and also EU grants C1PDCT925102, ERBC1PDCT 930105 & 940229. The central coordination was also supported by the World Health Organization, the European Foundation for Osteoporosis and Bone Disease, the Medical Research Council (G9321536), and the UK Arthritis Research Campaign. The EU’s PECO program linked to Biomed-1 funded in part the participation of the Budapest, Prague, and Piestany centers. The central X-ray evaluation was generously sponsored by the Bundesministerium fur Forschung and Technologie, Germany. Individual participating centers acknowledge the receipt of locally acquired support for their data collection. We would like to thank the following individuals: Czech Republic: Prague, M. Linduskova; Germany: Berlin Steglitz, I. Keller-Janker, B. Rothenburg; Berlin Postdam, C. Popovici; Bochum, M. Bohle, S. Hering, A. Pfeiffer, A. Weber, V. WieBe, H. Seelbach; Erfurt, M. Angrick, C. Dodenhof; Heidelberg, G. Leidig-Bruckner, B. Limberg; Jena, G. Lehmann, I. Marzoll; Lubeck, A. Raspe, E. Taubert; Greece: Athens, M. Katsiri, P. Papangelopoulou, G. Petta, P. Raptou; Poland: Szczecin, R. Celibala, E. Gromniak, A. Krzysztalowski, K. Napierata, J. Ogonowski; Portugal: Oporto, I. Brito, J. Brito, C. Maia, C. Vaz; Slovakia: Piestany, E. Brisudova, T. Hornakova, E. Martancikova, J. Tomkuljakova; Spain: Oviedo, C. Gomez Alonso, J.B. Diaz Lopez, A. Rodriguez Rebollar; Sweden: Malmo, A. Rafsted; United Kingdom: Aberdeen, R. Smith; Cambridge, A. Martin; Harrow, A. Nicholls, C. Oxbrough, L. Peter, O. Waldron, J. Walton, K. Walton; Truro, A. Deodhar, J. Parsons

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • T. W. O’Neill
    • 1
  • W. Cockerill
    • 1
  • C. Matthis
    • 2
  • H. H. Raspe
    • 2
  • M. Lunt
    • 1
  • C. Cooper
    • 3
  • D. Banzer
    • 4
  • J. B. Cannata
    • 5
  • M. Naves
    • 5
  • B. Felsch
    • 6
  • D. Felsenberg
    • 7
  • J. Janott
    • 8
  • O. Johnell
    • 9
  • J. A. Kanis
    • 10
  • G. Kragl
    • 11
  • A. Lopes Vaz
    • 12
  • G. Lyritis
    • 13
  • P. Masaryk
    • 14
  • G. Poor
    • 15
  • D. M. Reid
    • 16
  • W. Reisinger
    • 17
  • C. Scheidt-Nave
    • 18
  • J. J. Stepan
    • 19
  • C. J. Todd
    • 20
  • A. D. Woolf
    • 21
  • J. Reeve
    • 22
  • A. J. Silman
    • 1
  1. 1.ARC Epidemiology Research UnitUniversity of ManchesterManchesterUK
  2. 2.Institute for Social MedicineMedical University of LubeckLubeckGermany
  3. 3.MRC Environmental Epidemiology UnitSouthampton General HospitalSouthamptonUK
  4. 4.Department of RadiologyBehring HospitalBerlinGermany
  5. 5.Asturia General HospitalOviedoSpain
  6. 6.Clinic for Internal MedicineJenaGermany
  7. 7.Department of Radiology and Nuclear MedicineFree UniversityBerlinGermany
  8. 8.Ruhr UniversityBochumGermany
  9. 9.Department of OrthopedicsLund UniversityMalmoSweden
  10. 10.Centre for Metabolic Bone DiseaseSheffieldUK
  11. 11.Medical AcademyErfurtGermany
  12. 12.Hospital de San JoaoOportoPortugal
  13. 13.Laboratory for the Research of Musculoskeletal SystemUniversity of AthensAthensGreece
  14. 14.Institute of Rheumatic DiseasesPiestanySlovakia
  15. 15.National Institute of Rheumatology and PhysiotherapyBudapestHungary
  16. 16.Department of Medicine and TherapeuticsUniversity of AberdeenAberdeenUK
  17. 17.Institute for Diagnostic RadiologyHumboldt UniversityBerlinGermany
  18. 18.Department of General PracticeUniversity of GoettingenGoettingenGermany
  19. 19.Department of MedicineCharles UniversityPragueCzech Republic
  20. 20.School of Nursing, Midwifery and Health VisitingUniversity of ManchesterManchesterUK
  21. 21.Department of RheumatologyRoyal Cornwall HospitalTruroUK
  22. 22.University Department of Medicine and Institute of Public HealthCambridgeUK

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