Clinical Grading of Spinal Osteoporosis: Quality of Life Components and Spinal Deformity in Women with Chronic Low Back Pain and Women with Vertebral Osteoporosis

Abstract

. Spinal X-rays were reviewed in all patients for the evidence of vertebral fractures. In osteoporotic patients, vertebral deformity was quantified by the spine deformity index (SDI) on X-rays. It was assessed whether subgroups could be identified by a combination of indices for spinal deformation (SDI, HR, DOW) using a cluster analysis. Back pain was a major complaint in both groups, without differences in pain intensity and frequency. Impairment of general well being and mood was found in about one-third of the patients in both groups. Independent of age, the disability score was significantly higher in patients with osteoporosis than in patients with CLBP. Both groups differed with respect to clinical measures of spinal deformity (HR, DOW, DIR). Among osteoporotic patients, parameters of quality of life were not linearly related to the degree of radiologically assessed vertebral deformity, but osteoporotic patients with two or more vertebral fractures tended to have more functional limitations than those with only one fracture. There was, however, a significant linear relationship between components of quality of life (disability score, pain) and clinical measures of spinal deformation (HR, DOW, DIR). The osteoporotic patients were subdivided into three clusters. The first group was characterized by low spinal deformation (2SDI, 2HR, 2DOW) and little impairment of quality of life. The second group had significantly greater spinal deformation (1SDI, 1HR, 1DOW) and significantly more pain and functional limitations. The third group was characterized by increased kyphosis, mainly caused by nonskeletal dysfunction (2SDI, 2HR, 1DOW), but pain and functional limitations were impaired to the same degree as in the second group with severe skeletal spinal deformation. We conclude that with respect to quality of life components, functional limitation is the most specific to spinal osteoporosis and is related to clinical measures of spinal deformation. Furthermore, spinal deformation and the clinical course of osteoporosis appears to be insufficiently reflected by radiological indices of vertebral deformity (such as SDI) alone. For grading the disease and for therapeutical concepts, radiological measures and clinical evaluation should be considered in combination. (J Bone Miner Res 1997;12:663-675)

Vertebroplasty and kyphoplasty: complementary techniques for the treatment of painful osteoporotic vertebral compression fractures. A prospective non-randomised study on 154 patients

“…The analysis of the current literature is confusing as far as the most appropriate timing of application of VP and KP is concerned. On the one hand, it is suggested that VP should be considered after a course of 3 months of conservative treatment [16]. On the other, supporters of KP suggest that the procedure should be done within 3 months from fracture to increase the likelihood of a favourable outcome [10], or even within a few days from fracture to achieve a good restoration of vertebral height [11].…”

“…Symptomatic VCFs (about 30% of all VCFs esteemed to occur in the western world) can be associated with decreased quality of life and increased mortality in the elderly [9,16]. Irrespective of fracture pain, disability associated with VCFs is apparently caused by changes in the alignment of the spine and related to the severity of spinal deformity [18].…”

Effects of Tibolone on Bone Mass in Postmenopausal Women

“…Half of the patients become dependent on other people᾿s help, and about one-third become completely immobile. [5,6] The number of hip fractures in the world in 1990 was 1.7 million, and it is expected that the number by 2050 will be 6.3 million as the incidence of hip fractures increases with age. Costs for hip fractures in 2002 were 48 billion dollars, and this will have a manifold increase in the coming years.…”

Vertebroplasty and kyphoplasty: complementary tecniques for the treatment of painful osteoporotic vertebral compression fractures

“…The analysis of the current literature is confusing as far as the most appropriate timing of application of VP and KP is concerned. On the one hand it is suggested that VP should be considered after a course of 3 months of conservative treatment 2 . On the other, supporters of KP suggest the procedure should be done within three months from fracture to increase the likelihood of a favourable outcome 16 , or even within a few days from fracture to achieve a good restoration of vertebral height 17 .…”