Pain and disability associated with new vertebral fractures and other spinal conditions

Although vertebral fractures are common among older women, little is known about associations with pain and disability. In this prospective study, fractures which occurred after the initial radiograph were strong predictors of back pain and disability at the end of followup, with odds ratios (OR) of approximately 4-5. Other, independently significant predictors were self-reported history of (1) disk disease (OR = 3-9), (2) traumatic back injury (OR = 4-7), and (3) spinal arthritis (OR = 3-6). In longitudinal analyses, new fractures were associated (OR = 6.4; 95% CI = 2.6, 15.6) with increases in back pain frequency (relative to pre-fracture levels). The association with prevalent fractures was weaker, and not significant (OR = 1.7; 95% CI = 0.5, 5.6). The pain frequency index increased approximately 3-fold, relative to pre-fracture levels. At the end of followup (mean = 3.5 years), the index was still two times greater than baseline. We conclude that associations with back pain and disability are greater in magnitude for new vertebral fractures than for prevalent fractures.