Influence of estrogen-progestin treatment on back pain and disability among slim premenopausal women with low lumbar spine bone mineral density - A 2-year placebo-controlled randomized trial

Study Design, A 2-year randomized controlled trial. Objectives. To examine the possible preventive or aggravating effect of est rogen-progestin treatment on the back symptoms of slim premenopausal women with low lumbar spine bone mineral density. Summary of Background Data. The incidence of back pain, sciatica, or both s tarts to increase clearly among 45-54-year-old Finnish women. Methods, Forty-eight 39- to 49-year-old premenopausal women with a body mas s index of 21 or less and a lumbar spine bone mineral density (L2-L4) of 1. 1 +/- 1 g/cm(3) or less compared with the normative population were recruit ed into the study. The women were assigned randomly to receive either estra diol-noretisteron acetate treatment or placebo. Back pain, symptoms, and di sability were assessed with the Million and Oswestry questionnaires and pai n drawings during the follow-up period at 0, 12, and 24 months. Inquiry als o was made concerning previous back pain and sciatica history. Results, There was a statistically significant decrease in nighttime back p ain (P < 0.001) and the total Oswestry disability scores (P < 0.004) in the hormone-treated group compared with the control group during the follow-up , but no statistically significant differences were found in daytime back p ain. At baseline, the cumulative incidence in a history of pain radiating f rom the buttock to the foot in this osteopenic study group was 31/48, (64.5 %; 95% CI 50.5-78.6), which is much more than the predicted 20/48, (42.4%; 95% CI 39.0-45.7) at this age according to a previous population study. The cumulative incidence of at la least one back pain episode 44/48, (91.7%; 9 5% CI 83.6-99.8) was somewhat higher in these participants than was predict ed for a comparative population of women this age, 38/48 (79.2%; 95% CI 70. 2-87.3). Conclusions. It seems that this regimen may have alleviating effects on nig httime back pain and functional back disability in slim osteopenic premenop ausal women.