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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2017

01-12-2017 | Original Article

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

Authors: Hiromitsu Toyoda, Shinji Takahashi, Masatoshi Hoshino, Kazushi Takayama, Kazumichi Iseki, Ryuichi Sasaoka, Tadao Tsujio, Hiroyuki Yasuda, Takeharu Sasaki, Fumiaki Kanematsu, Hiroshi Kono, Hiroaki Nakamura

Published in: Archives of Osteoporosis | Issue 1/2017

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Abstract

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.
Appendix
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Metadata
Title
Characterizing the course of back pain after osteoporotic vertebral fracture: a hierarchical cluster analysis of a prospective cohort study
Authors
Hiromitsu Toyoda
Shinji Takahashi
Masatoshi Hoshino
Kazushi Takayama
Kazumichi Iseki
Ryuichi Sasaoka
Tadao Tsujio
Hiroyuki Yasuda
Takeharu Sasaki
Fumiaki Kanematsu
Hiroshi Kono
Hiroaki Nakamura
Publication date
01-12-2017
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2017
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-017-0377-5

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