Health Impact Associated with Vertebral Deformities: Results from the European Vertebral Osteoporosis Study (EVOS)

Abstract

To study the association between vertebral deformities and subjective health outcome indicators, including back pain and disability, a cross-sectional survey with spinal radiographs and personal interviews was carried out in 36 study centres in 19 European countries on a total of 15,570 men and women aged 50-79 years (population-based stratified random samples). No interventions were done. The main outcome measures were the presence and intensity of current and previous back pain, functional capacity (ADL questionnaire) and overall subjective health. The presence and intensity of back pain and functional and health impairments varied within wide ranges with no obvious regional pattern. However, the associations between negative health outcomes and vertebral deformity were homogeneous between countries and between centres within countries. In logistic regression analyses weak but significant associations between the presence of vertebral deformities and various health indicators were demonstrated. The magnitude of the associations increased with severity and number of deformities. Compared with subjects without deformities those with low-grade deformities had no or only a weakly elevated risk for back pain, disability and impaired subjective health (odds ratios (OR) 1.2-1.3). The odds ratios increased for individuals with single severe deformities (OR 1.3-2.1) and were highest in those with multiple severe deformities (OR 1.7-4.2). The associations between vertebral deformities and negative health outcomes were stronger in men than in women. In this cross-sectional study radiologically assessed vertebral deformities were therefore weakly associated with both current and previous back pain as well as with functional and health impairments in both women and men. Multiple severe deformities were associated with severe and disabling back pain with stronger effects in men.

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

“…In the United States alone, over 700,000 VCFs occur annually. Percutaneous augmentation of vertebral fractures by vertebroplasty [2,14,42] or kyphoplasty [25,35,37,40] has been used as a minimally invasive method of stabilizing such fractures and thereby reducing the associated pain of fracture motion in patients who have failed nonoperative care, including spinal bracing, activity modification, or narcotic analgesic medications. Many reports to date suggest that at both short-and long-term followup, well-selected patients can expect pain relief that limits narcotic requirements and enhances function in up to 90% of cases treated with kyphoplasty [16,24,27,35,40,56,58].…”

Positive relationship between bone mineral density and low back pain in middle-aged women

“…In the results of the European Vertebral Osteoporosis Study, it was suggested that LBP and disability could be attributed to vertebral deformities [6,15], and that the strength of the association increases with the increasing number and severity of the deformities [20]. However, osteoporosis with vertebral deformity is generally not very common among middle-aged women [26], and as such it is difficult to regard such a condition as the main cause of LBP in this age group.…”

“…Many studies have been conducted on the various primary factors causing musculoskeletal disorders, and a positive association between vertebral deformity and LBP has been demonstrated in elderly people [6,9,14,15,20]. In spite of a large number of epidemiological surveys on the prevalence of LBP or BMD measurements in the general population, a relationship between the two has not been well documented, and the authors of several studies have even concluded that they were unable to find any evidence for such a relationship [4, 14,24].…”

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

“…For inclusion in the present study, the authors have considered patients seen from January 2003 to January 2005 with a diagnosis of painful VCF associated with primary (senile and postmenopausal) or secondary (long term steroid use) osteoporosis 3 . Osteoporosis was defined as a 2.5 or more standard deviations decrease in bone mineral density at observation 9 , and confirmed on bone biopsy in patients who were later operated on. Patients whose bone histology did not show features of osteoporosis (osteomalacia or neoplasm) were excluded from the study.…”