Pain-Related Determinants of Frailty in Osteoporotic Vertebral Compression Fractures

To investigate the prevalence and determinants of frailty, including pain, in patients with osteoporotic vertebral compression fracture (OVCF) and to elucidate the interrelationships among these factors using a structural equation modeling (SEM) approach.

Cross-sectional correlational study.

From October 2024 to May 2025, 400 patients with OVCF were recruited from two tertiary hospitals in Zhejiang Province, China. Data were collected through self-administered questionnaires, including the visual analog scale (VAS) for pain, Tampa scale for kinesiophobia (TSK), self-rating scale of sleep (SRSS), and Tilburg Frailty Indicator (TFI). Descriptive statistics and SEM were used to examine relationships among variables.

A total of 368 participants were included. The prevalence of frailty was 68.2%. The SEM demonstrated good model fit (χ²/df = 1.802, RMSEA = 0.047). Pain had both direct effects on frailty (β = 0.321, p < .001) and indirect effects through kinesiophobia and sleep quality (β = 0.359, p < .001), yielding a total effect of 0.679. Kinesiophobia showed direct (β = 0.267, p < .001) and indirect (β = 0.072, p < .001) effects on frailty, with a total effect of 0.338. Poor sleep quality was also directly associated with frailty (β = 0.283, p < .001).

This study demonstrated that the incidence of frailty among patients with OVCF is relatively high and clarified the chain pathway "pain → fear of movement → sleep quality → frailty," highlighting mediating roles that provide a theoretical basis for targeted interventions to reduce frailty risk and promote recovery.