Exploring the association between vertebral fracture characteristics and pain

Vertebral fractures are commonly associated with chronic pain.Purpose: To explore, in women with osteoporotic vertebral fractures, the association between self-reported pain and factors such as the number, severity, and location of fractures, and pain medication usage. Methods: We conducted a secondary analysis of baseline data from all 141 participants from the Build Better Bones with Exercise (B3E) randomized controlled trial. Lateral spinal radiographs were taken and then analyzed by a radiologist to the confirm number, location and severity of vertebral fractures using the Genant criteria. We used a 10-point visual-analogue scale (VAS) to assess self-reported pain during movement in the preceding week. We developed one multivariable model to assess the association of the number, severity, and location of fractures with pain during movement. We created a second model adjusting for variability attributable to pain medication usage and age.Results: Participants were a mean+/-SD age of 76.4+/-6.9 years and 70% were on antiresorptive medications. There was no statistically significant association between pain and fracture number (adjusted Beta = 0.150, 95% CI: -0.305,0.653), severity (adjusted Beta = -0.088, 95% CI: -1.143, 0.916), or location between T4-T8 (adjusted Beta = -0.011, 95% CI: -1.247, 1.387), T9-L1 (adjusted Beta = 0.057, 95% CI: -0.975, 1.982), and L2-L4 (adjusted Beta = 0.068, 95% CI: -0.869, 1.929). Age and pain medication use were also not significantly associated with pain. The unadjusted and adjusted models accounted for 4.7% and 7.2% of the variance in self-reported pain, respectively. Conclusion: Pain in women with vertebral fractures may not be primarily explained by the number, location or severity of fractures.