Lateral back pain identifies prevalent vertebral fractures in post-menopausal women: cross-sectional analysis of a primary care-based cohort.

OBJECTIVE: Vertebral fractures (VFs) are frequently under-recognized, reflecting their lack of diagnostic clinical features. For example, although VFs are associated with back pain, this is also common in the general population. To establish whether back pain can be used to recognize patients with VF, we investigated the site of pain in people with and without VFs using a simple tool. METHODS: A cohort of 504 post-menopausal women was recruited from primary care in South West UK. Back pain was assessed by self-completion of the Margolis pain diagram, and analysis was modified to assess whether pain was mid-line or lateral. VFs were diagnosed by the algorithm-based qualitative method on radiographs. A cross-sectional analysis was carried out to assess the association between back pain and VFs. RESULTS: Three hundred and twenty-two women (64.1%) reported back pain over the last 12 months. Thirty seven (7.3%) had one or more VFs. In women with back pain, the presence of lateral waist area pain was associated with a 4.5-fold increased risk of VFs [odds ratio (OR) 4.48; 95% CI 2.02, 9.94; P < 0.001]. CONCLUSIONS: In post-menopausal women with back pain, the presence of lateral waist pain, as shown on the Margolis pain diagram, may identify women at higher risk of prevalent VF.

Seasonal variation in the incidence of wrist and forearm fractures, and its consequences.

We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of wrist and forearm fractures. We examined seasonal variation in the incidence of these injuries, and looked at resulting pressures on outpatient and inpatient trauma services. AWISS collected data from eight Accident and Emergency (A&E) departments which between them serve a total of 1.2 million people in South Wales. During a single year, we identified all 5013 people who presented with a wrist or forearm fracture. Seasonal variation in wrist/forearm fracture incidence was apparent, but showed a different pattern in different age groups. Overall incidence figures were dominated by an increase in children's fractures in spring and summer. Children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year). In contrast, older people showed a higher incidence in the winter. During the winter months people aged over 75 sustained a total of 160 wrist/forearm fractures; an incidence of 8.2/1000 per year, significantly higher than the incidence observed in other months (5.8/1000 per year). Seasonality of incidence was not apparent in other age groups. Children presenting during the spring and summer months were significantly more likely to need admission to hospital; 22.8% were admitted compared with just 10.3% of those presenting during the winter months (P<0.001, chi(2)-test). Other age groups showed no significant seasonal variation in the likelihood of hospital admission.