R M Joakimsen1, G K Berntsen, V Fønnebø. 1. Seksjon for forebyggende medisin, Institutt for samfunnsmedisin, Universitetet i Tromsø, 9037 Tromsø. Ragnar.Joakimsen@ism.uit.no
Abstract
BACKGROUND: The term osteoporosis often conjures up an image of deformed spines,--small stooping ladies burdened with back pain. Most modern medication against osteoporosis has documented effect first and foremost against vertebral fractures. However, are vertebral fractures a public health issue, and are they frequent and serious enough to warrant aggressive and expensive preventive measures? MATERIAL AND METHODS: Through search in Medline with the terms "osteoporosis", "vertebral fracture*" and "vertebral deformities", we identified and reviewed a total of 222 scientific articles on vertebral fractures. RESULTS: Incident vertebral deformities entail temporary complaints, and the consequences of prevalent deformities are minute unless there are several deformities. Less than 8% of back pain among the elderly can be attributed to vertebral deformities. A large double-blind, randomised clinical trial demonstrates that treatment that halves the risk of new vertebral deformities barely affects the occurrence of back pain or disability. INTERPRETATION: Even if some patients' suffering is attributable to vertebral deformities, we conclude that vertebral deformities represent a minor public health problem. As a consequence, studies exploring predictors of painful vertebral fractures are warranted; furthermore, more documentation on prevention of non-vertebral fractures is needed.
BACKGROUND: The term osteoporosis often conjures up an image of deformed spines,--small stooping ladies burdened with back pain. Most modern medication against osteoporosis has documented effect first and foremost against vertebral fractures. However, are vertebral fractures a public health issue, and are they frequent and serious enough to warrant aggressive and expensive preventive measures? MATERIAL AND METHODS: Through search in Medline with the terms "osteoporosis", "vertebral fracture*" and "vertebral deformities", we identified and reviewed a total of 222 scientific articles on vertebral fractures. RESULTS: Incident vertebral deformities entail temporary complaints, and the consequences of prevalent deformities are minute unless there are several deformities. Less than 8% of back pain among the elderly can be attributed to vertebral deformities. A large double-blind, randomised clinical trial demonstrates that treatment that halves the risk of new vertebral deformities barely affects the occurrence of back pain or disability. INTERPRETATION: Even if some patients' suffering is attributable to vertebral deformities, we conclude that vertebral deformities represent a minor public health problem. As a consequence, studies exploring predictors of painful vertebral fractures are warranted; furthermore, more documentation on prevention of non-vertebral fractures is needed.