Influence of estrogen-progestin treatment on back pain and disability among slim premenopausal women with low lumbar spine bone mineral density. A 2-year placebo-controlled randomized trial.
METHODS
A 2-year randomized controlled trial.


OBJECTIVE
To examine the possible preventive or aggravating effect of estrogen-progestin treatment on the back symptoms of slim premenopausal women with low lumbar spine bone mineral density.


BACKGROUND
The incidence of back pain, sciatica, or both starts to increase clearly among 45-54-year-old Finnish women.


METHODS
Forty-eight 39- to 49-year-old premenopausal women with a body mass index of 21 or less and a lumbar spine bone mineral density (L2-L4) of 1.1 +/- 1 g/cm3 or less compared with the normative population were recruited into the study. The women were assigned randomly to receive either estradiol-noretisteron acetate treatment or placebo. Back pain, symptoms, and disability were assessed with the Million and Oswestry questionnaires and pain drawings during the follow-up period at 0, 12, and 24 months. Inquiry also was made concerning previous back pain and sciatica history.


RESULTS
There was a statistically significant decrease in nighttime back pain (P < 0.001) and the total Oswestry disability scores (P < 0.004) in the hormone-treated group compared with the control group during the follow-up, but no statistically significant differences were found in daytime back pain. At baseline, the cumulative incidence in a history of pain radiating from the buttock to the foot in this osteopenic study group was 31/48, (64.5%; 95% CI 50.5-78.6), which is much more than the predicted 20/48, (42.4%; 95% CI 39.0-45.7) at this age according to a previous population study. The cumulative incidence of at least one back pain episode 44/48, (91.7%; 95% CI 83.6-99.8) was somewhat higher in these participants than was predicted for a comparative population of women this age, 38/48 (79.2%; 95% CI 70.2-87.3).


CONCLUSIONS
It seems that this regimen may have alleviating effects on nighttime back pain and functional back disability in slim osteopenic premenopausal women.
Kyllönen
E S
ES
Department of Physical Medicine and Rehabilitation, Oulu University, Finland. eero.kyllonen@oulu.fi
Väänänen
H K
HK
Vanharanta
J H
JH
Heikkinen
J E
JE
D000328:Adult; D015992:Body Mass Index; D015519:Bone Density / Q000187:drug effects*; D002940:Circadian Rhythm; D004185:Disability Evaluation; D004958:Estradiol / Q000627:therapeutic use*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D017116:Low Back Pain / Q000453:epidemiology / Q000517:prevention & control / Q000534:rehabilitation*; D008159:Lumbar Vertebrae / Q000378:metabolism*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D017697:Premenopause; D011372:Progestins / Q000627:therapeutic use*; D011795:Surveys and Questionnaires
D011372:Progestins; D004958:Estradiol