RESEARCH - Lateral back pain identifies vertebral fractures in post-menopausal women

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Rheumatology Advance Access published online on December 16, 2009

Rheumatology, doi:10.1093/rheumatology/kep414

Lateral back pain identifies prevalent vertebral fractures in

post-menopausal women: cross-sectional analysis of a primary

care-based cohort

Emma M. 1, Alison P. Hutchinson1, Eugene V. McCloskey2, Mike D.

Stone3, C. 4, Ashok K. Bhalla5 and Jon H. Tobias1

1Clinical Science at North Bristol, University of Bristol, Southmead

Hospital, Bristol, 2WHO Collaborating Centre for Metabolic Bone

Diseases, University of Sheffield, Sheffield, 3Bone Research Unit,

Llandough Hospital, Penarth, 4Royal Glamorgan Hospital, Llantrisant

and 5Royal National Hospital for Rheumatic Diseases, Bath, UK.

Abstract

Objective. Vertebral fractures (VFs) are frequently under-recognized,

reflecting their lack of diagnostic clinical features. For example,

although VFs are associated with back pain, this is also common in the

general population. To establish whether back pain can be used to

recognize patients with VF, we investigated the site of pain in people

with and without VFs using a simple tool.

Methods. A cohort of 504 post-menopausal women was recruited from

primary care in South West UK. Back pain was assessed by

self-completion of the Margolis pain diagram, and analysis was

modified to assess whether pain was mid-line or lateral. VFs were

diagnosed by the algorithm-based qualitative method on radiographs. A

cross-sectional analysis was carried out to assess the association

between back pain and VFs.

Results. Three hundred and twenty-two women (64.1%) reported back pain

over the last 12 months. Thirty seven (7.3%) had one or more VFs. In

women with back pain, the presence of lateral waist area pain was

associated with a 4.5-fold increased risk of VFs [odds ratio (OR)

4.48; 95% CI 2.02, 9.94; P < 0.001].

Conclusions. In post-menopausal women with back pain, the presence of

lateral waist pain, as shown on the Margolis pain diagram, may

identify women at higher risk of prevalent VF.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep414v1?papetoc

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