© 1991 British Society for Rheumatology
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CLINICAL PROFILE OF ACUTE VERTEBRAL COMPRESSION FRACTURES IN OSTEOPOROSIS
*University Department of Medicine, Royal Infirmary Glasgow, G31 2ER
Departments of Rheumatology and Geriatric Medicine, Addenbrooke's Hospital Cambridge, CB2 2QQ
Correspondence to:
Corespondence to Dr U. Patel, Department of Radiology, Middlesex Hospital, Mortimer Street, London W1N 8AA
Thirty patients with acute, painful vertebral compression fracture were studied. Certain vertebrae, namely T8, T12, L1 and L4, were more likely to fracture. The majority occurred spontaneously (46%) or after trivial strain (36%). Of the former, 30% occurred whilst in bed. Radiation to the flanks and anteriorly was common (66%) but leg radiation was uncommon (6%). Associated symptoms noted were: nausea (26%), abdominal pain (20%), chest pain (13%). Straining exacerbated pain in only 60%. The position of comfort was lying flat (43%) or sitting (36%) but 16% found standing or walking most comfortable.
The correct diagnosis was made at the first visit in only 43% of patients. In the remainder there was a mean delay of 4.5 days before diagnosis. This poor diagnostic rate may be improved if other clinical features of osteoporosis such as kyphosis and a previous history of wrist and hip fractures are recorded, particularly when acute back pain occurs in bed. Full thoracic and lumbar X-rays may be required because pain and site of pathology may not coincide. Bone scanning may be necessary if immediate X-rays are normal. In early management the position of most comfort may be preferable to complete bed rest.
KEY WORDS: Acute vertebral fracture, Site, Clinical profile, Diagnostic features, Management
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