IS THERE A RELATIONSHIP BETWEEN MILD-MODERATE BACK PAIN AND FRAGILITY FRACTURES? ORIGINAL INVESTIGATION

Dalila Scaturro, Lorenza Lauricella, Luigi Giuseppe Tumminelli, Sofia Tomasello, Giulia Letizia Mauro

Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo

Introduction: Fragility fractures are the cause of 43 thousand deaths: 50% are caused by femur fractures, 28% by vertebral fractures and 22% by various fractures in women, in men the percentages are 47%, 39% and 14% respectively. Vertebral fractures are the most common, 30-50% women over age 50 will experience one of them. Worldwide, is estimated that a new vertebral fracture occurs every 22 seconds. Additionally, vertebral fractures strongly predict the risk of both further fractures and re-fractures, in any skeletal segment. Vertebral fractures are often asymptomatic. Early diagnosis of these is extremely important. The aim of the study is to show, within a population of women over-50 in post-menopause,  the correlation between mild-moderate back pain and fragility fractures, pain intensity and number of fractures to decide an early diagnostic path reducing new fractures risk.

Materials and method: This observational study was conducted between January 2016 and January 2018 with a total examination of 4000 physiatric outpatient, 615 were over 50 years old woman with back pain for at least 3 months not responding to conservative treatment and with NRS between 2 and 4; 513 patients have been enrolled in this study. All patients are physiatric outpatient at the U.O.C. of Rehabilitation of University Hospital “P. Giaccone” of Palermo. We include Post-menopausal women over 50, having intermittent back pain for for at least 3 months, not responding to conservative treatment, with NRS between 2 and 4 and SF 36 between  60 and 100.  We do not include patient with rheumatological pathologies, recent traumas, bone metastasis, osteomyelitis and previous vertebral fracture. All patients underwent a instrumental examination was also conducted with a dorsal-lombar X-Ray (L/L), in standing position. The semi-quantitative morphometric Genant method was used for the diagnosis of the vertebral fractures.

Result: Data analysis showed that 41% (213/513) have vertebral fractures at dorsal-lombar X- Ray in L/L projection, using the semi-quantitative morphometric Genant method. 685 vertebral fractures have been shown with an average of 3.2 per patient: 74,59% are dorsal vertebral fractures and 24.1% are lombar. 77.5 % (165) of patients referred an NRS rate between 2 and 3 (first group) and 22.5% (48) a rate of 4 (second group). 66.1% of patients belonging to the first group showed more than 3 fractures and 33.9% from 1 to 2 vertebral fractures. 89.6% of patients belonging to second group has more than 3 fracture, 10.4% from 1 to 2 vertebral fractures.The Fischer test showed a P-value <0,001 regarding correlation between NRS and number of vertebral fragility fractures.

Conclusion: As we underline in the introduction, vertebral fractures are usually asymptomatic and, consequently undiagnosed. This observational study demonstrate that mild-moderate back pain, in post menopause woman resistant to conservative therapy and still with a good quality of life, is a significant symptom for an early diagnosis of vertebral fragility fractures.