The prevalence of vertebral fractures in patients attending Internal Medicine outpatient clinics

Background: Fractures are a clinical complication of osteoporosis, and among them vertebral fractures (VF) are the most frequent. This type of fracture is often asymptomatic or happens unnoticed and is not diagnosed. Objective: To study the prevalence of previously non-diagnosed vertebral fractures in a population of post menopausal women over 50, who have attended an Internal Medicine outpatient clinic because of chronic back pain. Material and methods: 273 women participated in the study, which comprised a group of cases (Group I) and a control group (Group II). Group I consisted of 202 post-menopausal women who had chronic back pain at the time they attended one of 13 Internal Medicine outpatient clinics across Spain. Group II was made up of 71 women who did not have back pain, and who were used as controls. To register any risk factors for osteoporosis, and any clinical symptoms, a questionnaire, previously validated and used in other similar clinical studies by SEIOMM members, was completed for all the female patients. A lateral thoracic and lumbar X-ray was also carried out on all female patients. The interpretation of the X-rays was done centrally. The Genant criteria for vertebral deformity were used for the diagnosis of the vertebral fractures. Results: The post-menopausal women with chronic back pain were shorter in height than those who did not have back pain (154 +/- 7.7 cm compared with 157 +/- 7.7 cm, p= 0.005), they had a greater prevalence of kyphosis (54% vs 32.4%) and a higher prevalence of VF (15.8% vs 2.8%, p= 0.004). No statistically significant differences in the prevalence of fractures in total, hip fractures, Colles fractures and other fractures, were found between the two groups. BMI, VFs and kyphosis showed an independent and statistically significant association with back pain. Conclusions: At the time of the study 15.8% of post-menopausal women with chronic back pain presented with at least one VF. In addition, they had a higher prevalence of kyphosis, and were on average 3 cm shorter, than the women without back pain. Given that these fractures were not previously diagnosed, we suggest carrying out a lateral thoracic-lumbar X-ray on these patients, in order to establish a diagnosis and to start treatment as soon as possible.