Arthritis or fracture? Figuring out what back pain means

It’s an unusual person who gets to middle age without a few aches and pains — a little wear and tear is to be expected after a half century or so. But for those at risk of osteoporotic fractures, back pain is particularly worrisome because you can’t really know whether it’s tired muscles, or arthritis, or a vertebral fracture.

Or can you?

Recent research shows that the pain caused by vertebral fractures is different from other causes, such as arthritis of the spine. As a 2016 study published in Osteoporosis International found, vertebral fractures in women produced a number of distinct pain signposts that weren’t present in women who had arthritis of the spinal column.

Recognizing the signs

The study looked at 197 British women between the ages of 67 and 84, asking them to report on their experiences of pain (in the back but elsewhere as well) before initiating a spine x-ray to look for vertebral fractures. They found that about a third of the women had vertebral fractures — and the women with fractures had a number of things in common. They were older (average age of 76.9 years versus 71.7 in the women without fractures), were considerably more likely to have had a previous fracture, or a diagnosis of osteoporosis, or both, and had fairly specific attributes to the pain they experienced that differed from the women with arthritis.

Most notably, women with fractures described their pain as recent and brief in duration but “crushing,” whereas women with arthritis said they had intermittent or periodic pain that they were more likely to call “taut” or “sharp.” Radiation of pain to the legs and association with weather changes were common in the women with arthritis but not the women with vertebral fractures. (See table for full comparison.)

Table: Women’s experience of vertebral fracture pain

	Vertebral fracture	Arthritis
Risk factors	Older age Previous fracture (nonvertebral) Diagnosis of osteoporosis
Duration of pain	Short-term, recent (occurring within days or weeks of the study); episodes are brief or transient with no apparent pattern	Long-term (present months or years prior to study); episodes are “periodic” or intermittent
Onset	Sudden	Gradual
Type of pain	“Crushing” but localized	Pain description varies but it is ongoing or intermittent and may occur anywhere from neck to legs
Other	Relieved by lying down Does not radiate to legs No obvious association to weather or temperature	No clear effect on pain of keeping still or moving May radiate to legs Some associations with cold, damp, or changing weather conditions

Listening to your body

All of this makes sense. Fractures are an acute injury in the bone, which is very different from the kind of slow, gradual, and chronic inflammatory process that is present in arthritis.

What I take away from this study is that our body will tell us what we need to know — if we listen carefully. To start learning more about your bone health and risk for fracture, I encourage you to take our quick and easy Bone Health Profile.

 

Reference: 

Clark EM, Gooberman-Hill R, Peter TJ. Using self-reports of pain and other variables to distinguish between older women with back pain due to vertebral fractures and those with back pain due to degenerative changes. Osteoporos Int 2016;27:1459–1467.