Characterizing the course of back pain after osteoporotic vertebral fracture: a hierarchical cluster analysis of a prospective cohort study

• Published in: Archives of osteoporosis 2017-09, Vol.12 (1), p.82-82, Article 82
• Main Authors: Toyoda, Hiromitsu, Takahashi, Shinji, Hoshino, Masatoshi, Takayama, Kazushi, Iseki, Kazumichi, Sasaoka, Ryuichi, Tsujio, Tadao, Yasuda, Hiroyuki, Sasaki, Takeharu, Kanematsu, Fumiaki, Kono, Hiroshi, Nakamura, Hiroaki
• Format: Article
• Language: English
• Subjects: Aged; Back Pain - diagnosis; Back Pain - etiology; Back Pain - therapy; Cluster Analysis; Cohort Studies; Disease Management; Endocrinology; Female; Humans; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Osteoporotic Fractures - complications; Osteoporotic Fractures - diagnostic imaging; Pain Measurement - methods; Radiography - methods; Risk Factors; Spinal Fractures - complications; Spinal Fractures - diagnostic imaging; Spinal Fractures - etiology; Spine - diagnostic imaging
• ISSN: 1862-3522; 1862-3514
• DOI: 10.1007/s11657-017-0377-5

Summary This study demonstrated four distinct patterns in the course of back pain after osteoporotic vertebral fracture (OVF). Greater angular instability in the first 6 months after the baseline was one factor affecting back pain after OVF. Purpose Understanding the natural course of symptomatic acute OVF is important in deciding the optimal treatment strategy. We used latent class analysis to classify the course of back pain after OVF and identify the risk factors associated with persistent pain. Methods This multicenter cohort study included 218 consecutive patients with ≤ 2-week-old OVFs who were enrolled at 11 institutions. Dynamic x-rays and back pain assessment with a visual analog scale (VAS) were obtained at enrollment and at 1-, 3-, and 6-month follow-ups. The VAS scores were used to characterize patient groups, using hierarchical cluster analysis. Results VAS for 128 patients was used for hierarchical cluster analysis. Analysis yielded four clusters representing different patterns of back pain progression. Cluster 1 patients (50.8%) had stable, mild pain. Cluster 2 patients (21.1%) started with moderate pain and progressed quickly to very low pain. Patients in cluster 3 (10.9%) had moderate pain that initially improved but worsened after 3 months. Cluster 4 patients (17.2%) had persistent severe pain. Patients in cluster 4 showed significant high baseline pain intensity, higher degree of angular instability, and higher number of previous OVFs, and tended to lack regular exercise. In contrast, patients in cluster 2 had significantly lower baseline VAS and less angular instability. Conclusions We identified four distinct groups of OVF patients with different patterns of back pain progression. Understanding the course of back pain after OVF may help in its management and contribute to future treatment trials.