Factors Contributing to Residual Low Back Pain after Osteoporotic Vertebral Fractures

Abstract

Although osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have investigated the factors contributing to residual low back pain in the chronic phase after OVFs by using radiographic evaluation. We examined the contribution of nonunion, vertebral deformity, and thoracolumbar alignment to the severity of residual low back pain post-OVF. This post hoc analysis of a prospective randomized study included 195 patients with a 48-week follow-up period. We investigated the associations between radiographic variables with the visual analog scale (VAS) scores for low back pain at 48 weeks post-OVF using a multiple linear regression model. Univariate analysis revealed that analgesic use, the local angle on magnetic resonance imaging, anterior vertebral body compression percentage on X-ray, and nonunion showed a significant association with VAS scores for low back pain. Multiple regression analysis produced the following equation: VAS for low back pain at 48 weeks = 15.49 + 0.29 × VAS for low back pain at 0 weeks + (with analgesics: +8.84, without analgesics: −8.84) + (union: −5.72, nonunion: −5.72). Among local alignment, thoracolumbar alignment, and nonunion, nonunion independently contributed to residual low back pain at 48 weeks post-OVF. A treatment strategy that reduces the occurrence of nonunion is desirable.

Subsequent Domino Osteoporotic Vertebral Fractures Adversely Affect Short-Term Health-Related Quality of Life: A Prospective Multicenter Study

“…A total of 86% of our patients initiated anti-osteoporosis treatment after new OVFs, and 49.3% used anabolic agents. Several previous studies on the conservative management of OVFs did not incorporate anabolic agents, leading to a presumed lower incidence of subsequent domino OVFs in the current study [ 3 , 6 , 12 , 22 , 23 ]. However, the results of this study indicate that anti-osteoporosis treatment did not prevent domino OVFs.…”

“…Despite the possibility of an earlier onset of domino OVFs, assessing the clinical outcome at 1 month would be challenging as it would be difficult to discriminate between the source of pain arising from the initial OVF and that from the domino OVFs. Several recent studies have reported that pain and QOL significantly improve after 3 months of conservative treatment for OVFs [ 11 , 21 , 22 ]. Therefore, our study evaluated clinical outcomes and image assessments at the 3-month mark.…”

“…In a subgroup analysis of domino OVFs, patients with adjacent OVFs and number of OVFs ≥ 3 had significantly severe functional disability. Previous studies have reported that non-union, severe vertebral collapse, angular instability, and MRI findings, such as T2 high-signal changes, were associated with residual LBP [ 11 , 22 , 23 ]. Hu et al reported that the number of OVFs was significantly correlated with global sagittal alignment, which was associated with a poorer QOL [ 24 ].…”

Bioactive mineralized small intestinal submucosa acellular matrix/PMMA bone cement for vertebral bone regeneration

“…Osteoporosis is a condition of the bones characterized by decreased bone density and compromised bone architecture, leading to a higher susceptibility to bone fractures [ 2 , 3 ]. The most prevalent form of fracture caused by osteoporosis is osteoporotic vertebral compression fracture (OVCF) [ 4 , 5 ], with ∼1.4 million new cases estimated each year globally [ 6 ]. OVCF is primarily characterized by severe low back pain, which can severely limit mobility, significantly diminish the patient’s quality of existence and even pose a risk of fatality [ 7 , 8 ].…”

Risk of Revision After Vertebral Augmentation for Osteoporotic Vertebral Fracture: A Narrative Review

“…Despite conservative treatment, residual back pain and neurological deficit are observed due to nonunion, severe deformity, and global spinal imbalance [ 13 - 15 ]. Particularly, nonunion is strongly associated with residual back pain compared to local alignment [ 16 ].…”