Lateral back pain identifies prevalent vertebral fractures in post-menopausal women: cross-sectional analysis of a primary care-based cohort.
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.
Clark
Emma M
EM
University of Bristol, Southmead Hospital, Bristol BS10 5NB, UK. emma.clark@bristol.ac.uk
Hutchinson
Alison P
AP
McCloskey
Eugene V
EV
Stone
Mike D
MD
Martin
James C
JC
Bhalla
Ashok K
AK
Tobias
Jon H
JH
D000368:Aged; D001296:Audiovisual Aids; D001416:Back Pain / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D010147:Pain Measurement / Q000379:methods; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications* / Q000175:diagnosis*