The Association of Radiographically Detected Vertebral Fractures with Back Pain and Function: A Prospective Study

Nevitt, Michael C.; Ettinger, Bruce; Black, Dennis M.; Stone, Katie L.; Jamal, Sophie A.; Ensrud, Kristine E.; Segal, Mark R.; Genant, Harry K.; Cummings, Steve

doi:10.7326/0003-4819-128-10-199805150-00001

Cited by 765 publications

(439 citation statements)

References 34 publications

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“…Women without follow-up radiographs were older and reported poorer health at baseline compared with those who had follow-up radiographs (35). Vertebral fractures were identified by using computer-assisted morphometric evaluation (36), and incident vertebral fractures were defined as a 20% or greater and 4 mm or greater reduction in anterior, midvertebral, or posterior vertebral height between the baseline and follow-up radiographs (37).…”

Section: Ascertainment Of Incident Fracturesmentioning

confidence: 99%

Risk for Fracture in Women with Low Serum Levels of Thyroid-Stimulating Hormone

et al. 2001

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Section: Ascertainment Of Incident Fracturesmentioning

confidence: 99%

Risk for Fracture in Women with Low Serum Levels of Thyroid-Stimulating Hormone

et al. 2001

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“…Vertebral fractures are associated with a number of physical impairments and psychosocial morbidities and pose a significant burden on the public health system [12,32]. Furthermore, these sequelae become more pronounced with each subsequent vertebral fracture sustained [26].…”

Section: Introductionmentioning

confidence: 99%

Paraspinal muscle control in people with osteoporotic vertebral fracture

et al. 2007

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The high risk of sustaining subsequent vertebral fractures after an initial fracture cannot be explained solely by low bone mass. Extra-osseous factors, such as neuromuscular characteristics may help to explain this clinical dilemma. Elderly women with (n = 11) and without (n = 14) osteoporotic vertebral fractures performed rapid shoulder flexion to perturb the trunk while standing on a flat and short base. Neuromuscular postural responses of the paraspinal muscles at T6 and T12, and deep lumbar multifidus at L4 were recorded using intramuscular electromyography (EMG). Both groups demonstrated bursts of EMG that were initiated either before or shortly after the onset of shoulder flexion (P < 0.05). Paraspinal and multifidus onset occurred earlier in the non-fracture group (50-0 ms before deltoid onset) compared to the fracture group (25 ms before and 25 ms after deltoid onset) in the flat base condition. In the short base condition, EMG amplitude increased significantly above baseline earlier in the non-fracture group (75-25 ms before deltoid onset) compared to the fracture group (25-0 ms before deltoid onset) at T6 and T12; yet multifidus EMG increased above baseline earlier in the fracture group (50-25 ms before deltoid) compared to the non-fracture group (25-0 ms before deltoid). Time to reach maximum amplitude was shorter in the fracture group. Hypothetically, the longer time to initiate a postural response and shorter time to reach maximum amplitude in the fracture group may indicate a neuromuscular contribution towards subsequent fracture aetiology. This response could also be an adaptive characteristic of the central nervous system to minimise vertebral loading time.

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“…(1) Hip fractures, vertebral fractures, and wrist fractures all have been shown to increase the risk of disability. (5,7,8,20) In addition to the reduction in vertebral, hip, and all clinical fractures reported previously with zoledronic acid in the HORIZON-PFT, (13) 3-year treatment with zoledronic acid significantly reduced the number of days that patients reported back pain, limited activity owing to back pain, and limited activity and bed rest after a fracture in comparison with placebo in postmenopausal women with osteoporosis.…”

Section: Discussionmentioning

confidence: 76%

Once-yearly zoledronic acid and days of disability, bed rest, and back pain: Randomized, controlled HORIZON Pivotal Fracture Trial

Cauley

Black

Boonen

et al. 2010

Journal of Bone and Mineral Research

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The objective of this study was to determine the effect of once-yearly zoledronic acid on the number of days of back pain and the number of days of disability (ie, limited activity and bed rest) owing to back pain or fracture in postmenopausal women with osteoporosis. This was a multicenter, randomized, double-blind, placebo-controlled trial in 240 clinical centers in 27 countries. Participants included 7736 postmenopausal women with osteoporosis. Patients were randomized to receive either a single 15-minute intravenous infusion of zoledronic acid (5 mg) or placebo at baseline, 12 months, and 24 months. The main outcome measures were selfreported number of days with back pain and the number of days of limited activity and bed rest owing to back pain or a fracture, and this was assessed every 3 months over a 3-year period. Our results show that although the incidence of back pain was high in both randomized groups, women randomized to zoledronic acid experienced, on average, 18 fewer days of back pain compared with placebo over the course of the trial ( p ¼ .0092). The back pain among women randomized to zoledronic acid versus placebo resulted in 11 fewer days of limited activity ( p ¼ .0017). In Cox proportional-hazards models, women randomized to zoledronic acid were about 6% less likely to experience 7 or more days of back pain [relative risk (RR) ¼ 0.94, 95% confidence interval (CI) 0.90-0.99] or limited activity owing to back pain (RR ¼ 0.94, 95% CI 0.87-1.00). Women randomized to zoledronic acid were significantly less likely to experience 7 or more bedrest days owing to a fracture (RR ¼ 0.58, 95% CI 0.47-0.72) and 7 or more limited-activity days owing to a fracture (RR ¼ 0.67, 95% CI 0.58-0.78). Reductions in back pain with zoledronic acid were independent of incident fracture. Our conclusion is that in women with postmenopausal osteoporosis, a once-yearly infusion with zoledronic acid over a 3-year period significantly reduced the number of days that patients reported back pain, limited activity owing to back pain, and limited activity and bed rest owing to a fracture. ß

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The Association of Radiographically Detected Vertebral Fractures with Back Pain and Function: A Prospective Study

Cited by 765 publications

References 34 publications

Risk for Fracture in Women with Low Serum Levels of Thyroid-Stimulating Hormone

Risk for Fracture in Women with Low Serum Levels of Thyroid-Stimulating Hormone

Paraspinal muscle control in people with osteoporotic vertebral fracture

Once-yearly zoledronic acid and days of disability, bed rest, and back pain: Randomized, controlled HORIZON Pivotal Fracture Trial

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