Back pain is a very common complaint and may be associated with various etiologies, among which osteoarthritis, discopathy and spinal stenosis are probably the most prevalent in the postmenopausal period. Osteoporosis per se, without a fracture or a change in vertebral morphology, is usually considered a silent disease condition. A recently published study in Japan , which recruited ambulatory postmenopausal women visiting their physician with back pain as a chief complaint, investigated possible co-morbidities and followed those women for future fractures (mean age at entry 62 ± 10 years, mean follow-up 5.7 ± 3 years). Each woman underwent bone densitometry and spinal radiography as part of the initial work-out. Patients who received medications that might affect bone metabolism (including vitamin D) and those severely ill or diagnosed as suffering from secondary osteoporosis or metabolic bone disease were excluded from the cohort. During the observation period, spine radiographs were done routinely every 1–2 years, or when there appeared symptoms suggestive of a fracture.
At baseline, 12% had prevalent fractures (vertebral, 9% or long bones, 3%), 18% had osteoporosis, 23% had osteoarthritis (based on the Kellgren–Lawrence score), and 4% suffered from rheumatoid arthritis. During the observation period, 23% developed a fracture without a high-energy trauma, mostly (78%) at the spine. A multivariate Cox regression analysis which included age, bone mineral density, pre-existing vertebral fracture and back pain as risk factors, demonstrated an independent contribution to the risk of future fractures for all the above factors that were included in the model. Osteoporosis by a bone mineral density testing was associated with a hazard ratio of 2.3 (95% confidence interval (CI) 1.23–1.50), and the values for a prevalent vertebral fracture and back pain were 1.92 (95% CI 1.20–3.06) and 1.62 (95% CI 1.16–2.27), respectively.
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel
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