CLINICAL GRADING OF SPINAL OSTEOPOROSIS - QUALITY-OF-LIFE COMPONENTS AND SPINAL DEFORMITY IN WOMEN WITH CHRONIC LOW-BACK-PAIN AND WOMEN WITH VERTEBRAL OSTEOPOROSIS

Clinical consequences of osteoporotic vertebral fractures, such as bac k pain, functional limitations, and impairment of mood, are often cite d as justification for prevention and therapy. But these symptoms are poorly characterized, and a clinical grading system is not available. The aim of this study was to compare clinical measures for spinal defo rmation and quality of life components between patients with osteoporo sis and patients with chronic low back pain (CLBP) and to determine th e relationship between spinal deformation and quality of life componen ts. A total of 130 female patients (63 osteoporotic patients, 65 +/- 7 .9 years, and 77 CLBP patients, 56 +/- 6.5 years) had a standardized i nterview on quality of life components (pain, activities of daily life , mood) and clinical measures of spinal deformation (height reduction [HR], distance from occiput to wall [DOW], and distance from iliac cre st to ribs [DIR]). Spinal X-rays were reviewed in all patients for the evidence of vertebral fractures. In osteoporotic patients, vertebral deformity was quantified by the spine deformity index (SDI) on X-rays. It was assessed whether subgroups could be identified by a combinatio n of indices for spinal deformation (SDI, HR, DOW) using a cluster ana lysis. Back pain was a major complaint in both groups, without differe nces in pain intensity and frequency. Impairment of general well being and mood was found in about one-third of the patients in both groups. Independent of age, the disability score was significantly higher in patients with osteoporosis than in patients with CLBP. Both groups dif fered with respect to clinical measures of spinal deformity (IIR, DOW, DIR). Among osteoporotic patients, parameters of quality of life were not linearly related to the degree of radiologically assessed vertebr al deformity, but osteoporotic patients with two or more vertebral fra ctures tended to have more functional limitations than those with only one fracture. There was, however, a significant linear relationship b etween components of quality of life (disability score, pain) and clin ical measures of spinal deformation (HR, DOW, DIR). The osteoporotic p atients were subdivided into three clusters. The first group was chara cterized by low spinal deformation (down arrow SDI, down arrow HR, dow n arrow DOW) and little impairment of quality of life. The second grou p had significantly greater spinal deformation (up arrow SDI, up arrow HR, up arrow DOW) and significantly more pain and functional limitati ons. The third group was characterized by increased kyphosis, mainly c aused by nonskeletal dysfunction (down arrow SDI, down arrow HR, down arrow DOW), but pain and functional limitations were impaired to the s ame degree as in the second group with severe skeletal spinal deformat ion. We conclude that,vith respect to quality of life components, func tional limitation is the most specific to spinal osteoporosis and is r elated to clinical measures of spinal deformation. Furthermore, spinal deformation and the clinical course of osteoporosis appears to be ins ufficiently reflected by radiological indices of vertebral deformity ( such as SDI) alone. For grading the disease and for therapeutical conc epts, radiological measures and clinical evaluation should be consider ed in combination.