European Spine Journal

, Volume 19, Issue 4, pp 567–574

Previous vertebral compression fractures add to the deterioration of the disability and quality of life after an acute compression fracture

Original Article

Abstract

Prevalent vertebral compression fracture(s) have been reported as having a negative impact on pain, disability, and quality of life. But no study has evaluated the effect of previous fracture on the course of acute compression fractures. The aim of the present study was to compare the natural course of the acute compression fracture in patients with (n = 51) and without (n = 56) previous vertebral compression fracture(s). The study is a retrospective analysis of a prospective cohort followed with postal questionnaires during a 12-month period after an acute fracture event. Eligible patients were those over 40 years of age, who were admitted to the emergency unit because of back pain and had an X-ray confirmed acute vertebral body fracture. A total of 107 patients were included in the study. The pain, disability (von Korff pain and disability scores), ADL (Hannover ADL score), and quality of life (QoL) (EQ-5D) were measured after 3 weeks, and 3, 6, and 12 months. The X-rays from the first visit to the emergency unit were evaluated. The difference of the scores between the groups with and without previous fracture was statistically significant (P < 0.05) at 3 weeks, 6 and 12 months for von Korff disability score, at all occasions for EQ-5D and at 3–12 months for Hannover ADL score, but only at 12 months for the von Korff pain intensity score. In both the groups all scores had improved in a statistically significant way at 3 months. The number of previous fractures was related to all the outcome scores in a statistically significant way (P < 0.05) except von Korff pain intensity score at 3 weeks and 3 months and von Korff disability score at 3 months. In conclusion, disability, ADL, and QoL scores, but not pain intensity score, were significantly worse in the patients with previous fracture from the fracture episode through the first 12 months. However, the improvements during the follow-up year seen in both groups were of a similar magnitude. The presence or absence of a previous fracture in an acutely fractured patient will influence the prognosis and thus possibly also the indications for treatments.

Keywords

Vertebral body fracture Osteoporosis Prevalent fracture Quality of life Disability Treatment 

References

  1. 1.
    Begerow B, Pfeifer M, Pospeschill M, Scholz M, Schlotthauer T, Lazarescu A, Pollaehne W, Minne HW (1999) Time since vertebral fracture: an important variable concerning quality of life in patients with postmenopausal osteoporosis. Osteoporos Int 10:26–33. doi:10.1007/s001980050190 CrossRefPubMedGoogle Scholar
  2. 2.
    Bengner U, Johnell O, Redlund-Johnell I (1988) Changes in incidence and prevalence of vertebral fractures during 30 years. Calcif Tissue Int 42:293–296. doi:10.1007/BF02556362 CrossRefPubMedGoogle Scholar
  3. 3.
    Bergenudd H, Nilsson B, Uden A, Willner S (1989) Bone mineral content, gender, body posture, and build in relation to back pain in middle age. Spine 14:577–579. doi:10.1097/00007632-198906000-00005 CrossRefPubMedGoogle Scholar
  4. 4.
    Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of osteoporotic fractures research group. J Bone Miner Res 14:821–828. doi:10.1359/jbmr.1999.14.5.821 CrossRefPubMedGoogle Scholar
  5. 5.
    Burger H, Van Daele PL, Grashuis K, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157. doi:10.1359/jbmr.1997.12.1.152 CrossRefPubMedGoogle Scholar
  6. 6.
    Chrischilles EA, Butler CD, Davis CS, Wallace RB (1991) A model of lifetime osteoporosis impact. Arch Intern Med 151:2026–2032. doi:10.1001/archinte.151.10.2026 CrossRefPubMedGoogle Scholar
  7. 7.
    Cockerill W, Ismail AA, Cooper C, Matthis C, Raspe H, Silman AJ, O’Neill TW (2000) Does location of vertebral deformity within the spine influence back pain and disability? European vertebral osteoporosis study (EVOS) group. Ann Rheum Dis 59:368–371. doi:10.1136/ard.59.5.368 CrossRefPubMedGoogle Scholar
  8. 8.
    Cockerill W, Lunt M, Silman AJ, Cooper C, Lips P, Bhalla AK, Cannata JB, Eastell R, Felsenberg D, Gennari C, Johnell O, Kanis JA, Kiss C, Masaryk P, Naves M, Poor G, Raspe H, Reid DM, Reeve J, Stepan J, Todd C, Woolf AD, O’Neill TW (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119. doi:10.1007/s00198-003-1547-4 CrossRefPubMedGoogle Scholar
  9. 9.
    Cortet B, Roches E, Logier R, Houvenagel E, Gaydier-Souquieres G, Puisieux F, Delcambre B (2002) Evaluation of spinal curvatures after a recent osteoporotic vertebral fracture. Joint Bone Spine 69:201–208. doi:10.1016/S1297-319X(02)00381-0 CrossRefPubMedGoogle Scholar
  10. 10.
    Davis JW, Grove JS, Wasnich RD, Ross PD (1999) Spatial relationships between prevalent and incident spine fractures. Bone 24:261–264. doi:10.1016/S8756-3282(98)00176-8 CrossRefPubMedGoogle Scholar
  11. 11.
    De Smet AA, Robinson RG, Johnson BE, Lukert BP (1988) Spinal compression fractures in osteoporotic women: patterns and relationship to hyperkyphosis. Radiology 166:497–500PubMedGoogle Scholar
  12. 12.
    Dolan P, Gudex C, Kind P, Williams A (1996) The time trade-off method: results from a general population study. Health Econ 5:141–154. doi:10.1002/(SICI)1099-1050(199603)5:2<141::AID-HEC189>3.0.CO;2-N CrossRefPubMedGoogle Scholar
  13. 13.
    Dolan P, Gudex C, Kind P, Williams A (1996) Valuing health states: a comparison of methods. J Health Econ 15:209–231. doi:10.1016/0167-6296(95)00038-0 CrossRefPubMedGoogle Scholar
  14. 14.
    Ensrud KE, Black DM, Harris F, Ettinger B, Cummings SR (1997) Correlates of kyphosis in older women. The fracture intervention trial research group. J Am Geriatr Soc 45:682–687PubMedGoogle Scholar
  15. 15.
    Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. The study of osteoporotic fractures research group. J Bone Miner Res 7:449–456CrossRefPubMedGoogle Scholar
  16. 16.
    Ettinger B, Black DM, Palermo L, Nevitt MC, Melnikoff S, Cummings SR (1994) Kyphosis in older women and its relation to back pain, disability and osteopenia: the study of osteoporotic fractures. Osteoporos Int 4:55–60. doi:10.1007/BF02352262 CrossRefPubMedGoogle Scholar
  17. 17.
    Finsen V (1988) Osteoporosis and back pain among the elderly. Acta Med Scand 223:443–449PubMedGoogle Scholar
  18. 18.
    Genant HK, Jergas M (2003) Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int 14(Suppl 3):S43–S55. doi:10.1007/s00198-003-1472-6 PubMedGoogle Scholar
  19. 19.
    Genant HK, Jergas M, Palermo L, Nevitt M, Valentin RS, Black D, Cummings SR (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis The study of osteoporotic fractures research group. J Bone Miner Res 11:984–996CrossRefPubMedGoogle Scholar
  20. 20.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMedGoogle Scholar
  21. 21.
    Gold DT (1996) The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 18:185S–189S. doi:10.1016/8756-3282(95)00500-5 CrossRefPubMedGoogle Scholar
  22. 22.
    Greendale GA, Barrett-Connor E, Ingles S, Haile R (1995) Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo study. J Am Geriatr Soc 43:955–961PubMedGoogle Scholar
  23. 23.
    Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case–control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9:508–515. doi:10.1007/s001980050178 CrossRefPubMedGoogle Scholar
  24. 24.
    Huang C, Ross PD, Wasnich RD (1996) Vertebral fractures and other predictors of back pain among older women. J Bone Miner Res 11:1026–1032CrossRefPubMedGoogle Scholar
  25. 25.
    Ismail AA, Cooper C, Felsenberg D, Varlow J, Kanis JA, Silman AJ, O’Neill TW (1999) Number and type of vertebral deformities: epidemiological characteristics and relation to back pain and height loss. European vertebral osteoporosis study group. Osteoporos Int 9:206–213. doi:10.1007/s001980050138 CrossRefPubMedGoogle Scholar
  26. 26.
    Itoi E (1991) Roentgenographic analysis of posture in spinal osteoporotics. Spine 16:750–756. doi:10.1097/00007632-199107000-00011 CrossRefPubMedGoogle Scholar
  27. 27.
    Jinbayashi H, Aoyagi K, Ross PD, Ito M, Shindo H, Takemoto T (2002) Prevalence of vertebral deformity and its associations with physical impairment among Japanese women: the Hizen–Oshima study. Osteoporos Int 13:723–730. doi:10.1007/s001980200099 CrossRefPubMedGoogle Scholar
  28. 28.
    Kalliomaki JL, Siltavuori L, Virtama P (1973) Stature and aging. J Am Geriatr Soc 21:504–506PubMedGoogle Scholar
  29. 29.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739. doi:10.1359/jbmr.2000.15.4.721 CrossRefPubMedGoogle Scholar
  30. 30.
    Kohlmann T, Raspe H (1996) Hannover functional questionnaire in ambulatory diagnosis of functional disability caused by backache. Rehabilitation (Stuttg) 35:I–VIIIGoogle Scholar
  31. 31.
    Leidig G, Minne HW, Sauer P, Wuster C, Wuster J, Lojen M, Raue F, Ziegler R (1990) A study of complaints and their relation to vertebral destruction in patients with osteoporosis. Bone Miner 8:217–229. doi:10.1016/0169-6009(90)90107-Q CrossRefPubMedGoogle Scholar
  32. 32.
    Lunt M, O’Neill TW, Felsenberg D, Reeve J, Kanis JA, Cooper C, Silman AJ (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513. doi:10.1016/S8756-3282(03)00248-5 CrossRefPubMedGoogle Scholar
  33. 33.
    Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601. doi:10.1016/0002-9343(93)90210-G CrossRefPubMedGoogle Scholar
  34. 34.
    Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800PubMedGoogle Scholar
  35. 35.
    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392. doi:10.1359/jbmr.2000.15.7.1384 CrossRefPubMedGoogle Scholar
  36. 36.
    Randell AG, Bhalerao N, Nguyen TV, Sambrook PN, Eisman JA, Silverman SL (1998) Quality of life in osteoporosis: reliability, consistency, and validity of the osteoporosis assessment questionnaire. J Rheumatol 25:1171–1179PubMedGoogle Scholar
  37. 37.
    Rao RD, Singrakhia MD (2003) Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management. J Bone Joint Surg Am 85-A:2010–2022PubMedGoogle Scholar
  38. 38.
    Resnick D (1985) Degenerative diseases of the vertebral column. Radiology 156:3–14PubMedGoogle Scholar
  39. 39.
    Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103:30S–42S. doi:10.1016/S0002-9343(97)90025-5 Discussion 42S–43SCrossRefPubMedGoogle Scholar
  40. 40.
    Ross PD, Davis JW, Epstein RS, Wasnich RD (1994) Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol 47:231–239. doi:10.1016/0895-4356(94)90004-3 CrossRefPubMedGoogle Scholar
  41. 41.
    Ross PD, Ettinger B, Davis JW, Melton LJ 3rd, Wasnich RD (1991) Evaluation of adverse health outcomes associated with vertebral fractures. Osteoporos Int 1:134–140. doi:10.1007/BF01625442 CrossRefPubMedGoogle Scholar
  42. 42.
    Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women. Osteoporos Int 3:120–126. doi:10.1007/BF01623272 CrossRefPubMedGoogle Scholar
  43. 43.
    Ryan PJ, Blake G, Herd R, Fogelman I (1994) A clinical profile of back pain and disability in patients with spinal osteoporosis. Bone 15:27–30. doi:10.1016/8756-3282(94)90887-7 CrossRefPubMedGoogle Scholar
  44. 44.
    Ryan PJ, Evans P, Gibson T, Fogelman I (1992) Osteoporosis and chronic back pain: a study with single-photon emission computed tomography bone scintigraphy. J Bone Miner Res 7:1455–1460CrossRefPubMedGoogle Scholar
  45. 45.
    Ryan SD, Fried LP (1997) The impact of kyphosis on daily functioning. J Am Geriatr Soc 45:1479–1486PubMedGoogle Scholar
  46. 46.
    Salaffi F, Cimmino MA, Malavolta N, Carotti M, Di Matteo L, Scendoni P, Grassi W (2007) The burden of prevalent fractures on health-related quality of life in postmenopausal women with osteoporosis: the IMOF study. J Rheumatol 34:1551–1560PubMedGoogle Scholar
  47. 47.
    Silverman SL, Minshall ME, Shen W, Harper KD, Xie S (2001) The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the multiple outcomes of raloxifene evaluation study. Arthritis Rheum 44:2611–2619. doi:10.1002/1529-0131(200111)44:11<2611::AID-ART441>3.0.CO;2-N CrossRefPubMedGoogle Scholar
  48. 48.
    Suzuki N, Ogikubo O, Hansson T (2008) The course of the acute vertebral body fragility fracture: its effect on pain, disability and quality of life during 12 months. Eur Spine J 17:1380–1390. doi:10.1007/s00586-008-0753-3 CrossRefPubMedGoogle Scholar
  49. 49.
    Suzuki N, Ogikubo O, Hansson T (2009) The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation. Eur Spine J 18:77–88. doi:10.1007/s00586-008-0847-y CrossRefPubMedGoogle Scholar
  50. 50.
    Twomey L, Taylor J (1985) Age changes in lumbar intervertebral discs. Acta Orthop Scand 56:496–499PubMedCrossRefGoogle Scholar
  51. 51.
    van Schoor NM, Ewing SK, O’Neill TW, Lunt M, Smit JH, Lips P (2008) Impact of prevalent and incident vertebral fractures on utility: results from a patient-based and a population-based sample. Qual Life Res 17:159–167. doi:10.1007/s11136-007-9287-0 CrossRefPubMedGoogle Scholar
  52. 52.
    Von Korff M, Deyo RA, Cherkin D, Barlow W (1993) Back pain in primary care. Outcomes at 1 year. Spine 18:855–862CrossRefGoogle Scholar
  53. 53.
    von Korff M, Ormel J, Keefe FJ, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149. doi:10.1016/0304-3959(92)90154-4 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
  2. 2.Department of Orthopaedics, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden

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