Vertebral deformity, back symptoms, and functional limitations among older women: the Framingham Study

Vertebral deformity is the most common manifestation of osteoporosis. The purpose of this study was to determine the relation between incident vertebral deformity and back symptoms; and limitations in nine specific functional activities. Subjects were participants in the Framingham Study, a longitudinal, population-based sample involving residents of Framingham, MA, USA. Subjects consisted of 444 surviving female members of the original cohort who had baseline (1968-1975) and follow-up (1992-1993) spine radiographs evaluated for deformity using a semiquantitative scale. Ages ranged from 72 to 96 years. At the follow-up examination, subjects were asked if they experienced pain, aching, or stiffness in their back on most days and if they had difficulty performing nine specific functional skills. We found that incident vertebral deformity was associated with limitations in several functional activities, most notably, pushing or pulling a large object (OR 2.51, 95% confidence interval 1.40, 4.52). For most activities, there was no increase in the risk of functional limitations among women with vertebral deformity who did not report back symptoms at the end of the follow-up compared with those without vertebral deformity or back symptoms. For several functional activities, individuals with both vertebral deformity and back symptoms had greater limitations than would be expected from the additive contribution of both conditions. Back symptoms were associated with limitations in most functional activities, even in the absence of vertebral deformity. Efforts to prevent and treat back pain, independent of vertebral deformity status, might help to reduce functional limitations in older women.