Osteoporosis is one of the most common long-term conditions to affect older women in the UK. Osteoporosis can lead to vertebral fractures (VFs). As well as an increased risk of further fractures, women with VFs who do not receive appropriate clinical care may experience chronic back pain, spinal deformity and an increased risk of hospitalisation. Despite this, less than a third of VFs come to clinical attention. Possible explanations for this include the high prevalence of all-cause back pain in older people.
Dr Emma Clark, Consultant Senior Lecturer in School of Clinical Sciences, University of Bristol, has recently completed a study to identify if we can use women's experiences of back pain to discriminate between older women with and without VFs that could be used as clinical indicators. The support for this study which was conducted in collaboration with Dr Rachel Gooberman-Hill and Professor Tim Peters (both from the University of Bristol) came from the Elizabeth Blackwell Institute’s Translational Acceleration and Knowledge Transfer (TRACK) Award.
Preliminary analysis has shown differences in the characteristics of pain experienced by women with and without VFs. Dr Clark’s work suggests that those with VFs have experienced pain for a shorter period of time compared to those with all-cause back pain. Early analysis also shows site of pain is important in distinguishing between those with and without VFs, with those with VFs less likely to have pain in the shoulders and neck area.
Initial analysis also indicates that women with VFs were more likely to use certain descriptors when characterising the pain. Specifically, they were more likely to choose words such as ‘crushing’, and less likely to use the word 'taut' when describing their pain.
The results of this study provide the first evidence that there is a difference in back pain between women with and without vertebral fractures. This study forms a basis for an important next step in conducting further research in this area and the team are in the process of securing further research funding.
It is possible that this will lead to development of a simple questionnaire that can be asked to all older people who attend their GP or A&E with back pain, to identify which people are likely to have a vertebral fracture and therefore will need a spinal X-ray. This would result in increased identification of people with VFs, more appropriate treatment with medications to reduce the risk of further fractures, and improved quality of life in the older population through reduced hip and other fractures.