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21-02-2010 | Bone health | Article

Lateral waist pain may indicate vertebral fracture


Free abstract

MedWire News: Postmenopausal women with lateral waist pain should be referred for further investigation, say UK researchers who believe back pain in this location points to vertebral fracture (VF).

VFs are underdiagnosed due to a lack of specific clinical features, explain Emma Clark (University of Bristol) and co-workers in Rheumatology journal.

To determine whether VF can be identified in postmenopausal women, the team asked 504 such patients to complete the Margolis pain diagram and determined whether their pain was midline or lateral. VFs were then diagnosed from radiographs.

Overall, 64.1% of the women reported having had back pain in the past 12 months and 7.3% were diagnosed with one or more VFs.

Women with VFs were more likely to report back pain (78.4% vs 62.7%) and midline pain was more common than lateral pain at all sites. However, 25.0% of patients with one and 15.4% of women with more than one VF reported no pain.

Analysis showed that women who reported pain in the lateral waist area were 4.48 times more likely to have a VF than women with back pain in other areas, and this factor remained significant after adjustment for age, weight, and height loss.

There was also a suggestion that women with midline waist area back pain were less likely to have VF, although this was not significant after adjustment.

“Our results confirm what is already well known: back pain is a predictor of new VF,” Clark et al conclude.

“However, our work extends this further and suggests that in women presenting with back pain to primary care, the presence of lateral waist pain may identify women at higher risk of VF.

“This novel analysis suggests that the routine use of this modified Margolis pain diagram, without any additional statistical analysis, may have a role during consultations in primary care for back pain in postmenopausal women – one of the most common reasons for a consultation with a general practitioner in the UK.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lynda Williams

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