Abstract
Spinal sagittal malalignment due to vertebral fractures (VFs) induces low back pain (LBP) in patients with osteoporosis. This study aimed to elucidate spinal sagittal malalignment prevalence based on VF number and patient characteristics in individuals with osteoporosis and spinal sagittal malalignment. Spinal sagittal alignment, and VF number were measured in 259 patients with osteoporosis. Spinal sagittal malalignment was defined according to the SRS-Schwab classification of adult spinal deformity. Spinal sagittal malalignment prevalence was evaluated based on VF number. In patients without VFs, bone mineral density, bone turnover markers, LBP scores and health-related quality of life (HRQoL) scores of normal and sagittal malalignment groups were compared. In 205 of the 259 (79.2%) patients, spinal sagittal malalignment was detected. Sagittal malalignment prevalence in patients with 0, 1, or ≥2 VFs was 72.1%, 86.0%, and 86.3%, respectively. All LBP scores and some subscale of HRQoL scores in patients without VFs were significantly worse for the sagittal malalignment group than the normal alignment group (p < 0.05). The majority of patients with osteoporosis had spinal sagittal malalignment, including ≥70% of patients without VFs. Patients with spinal sagittal malalignment reported worse LBP and HRQoL. These findings suggest that spinal sagittal malalignment is a risk factor for LBP and poor HRQoL in patients with osteoporosis.
Highlights
Scaturro et al reported that the severity of low back pain (LBP) is correlated with the number of vertebral fractures [11]. These findings indicate that VFs are closely correlated with sagittal spinal malalignment and affect LBP as well as health-related quality of life (HRQoL)
Miyakoshi et al reported that decreased lumbar lordosis (LL) and the limitation of total spinal extension are important risk factors for gait disturbance in patients with chronic LBP [23]. These findings indicate that osteoporosis patients with spinal sagittal malalignment, even those without VFs, had worse HRQoL and LBP compared with patients with normal spinal sagittal alignment
The majority of patients with osteoporosis had spinal sagittal malalignment, and more than 70% of patients without VFs, had spinal sagittal malalignment
Summary
Patients with osteoporosis often report low back pain (LBP), intermittent. LBP such as vague LBP due to standing or walking for a long stretch of time. The types of LBP reported tend be difficult to treat. LBP is controversial because its pathological mechanism has not been fully elucidated. Several factors, including high bone turnover [1], low muscle mass [2], and vertebral fractures (VFs) [3], have been reported to be associated with increased risk of LBP and osteoporosis. It is well known that VFs induce spinal sagittal malalignment in osteoporosis patients [4]
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