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The clinical relevance of vertebral fractures and low back pain in elderly men


Summary, in English

The number of vertebral fractures has increased during the last few decades.The increase could at least partly be explained by the increasing proportion of elderly in society since these fractures are more commonly found in elderly than in young individuals. Low bone mass and osteoporosis which are also partly related to aging are risk factors for fracture but both age and low bone mass are independent risk factors for fracture. Furthermore, a vertebral fracture is itself a risk factor for future fractures. Our knowledge regarding prevalent vertebral fractures and their association with future fractures and back pain is predominantly derived from studies in women. Whether the same applies to men is less evaluated. This thesis therefore focuses on elderly men.

In this thesis we cross-sectionally evaluated the epidemiology of prevalent vertebral fractures in elderly Swedish men and their association with back pain, low bone mass density and osteoporosis and prospectively evaluated if specific characteristics of prevalent vertebral fractures predict future fractures. In a cross-sectional study design we also identified factors associated with low back pain (LBP) and sciatica (SCI). Our aim was to evaluate (i) whether a prevalent vertebral fracture is associated with back pain in elderly men (ii) if a prevalent vertebral fracture and specific characteristics of a prevalent vertebral fracture is associated with back pain, low bone mineral density, osteoporosis and future fractures and (iii) whether lifestyle and social factors are more associated with not only low back pain but also sciatica in elderly men.

We used the Osteoporotic Fractures in Men Sweden (MrOs) Study, a population-based cohort of 3014 community dwelling men aged 69—81 years recruited in the cities of Malmö (n=1005), Gothenburg (n=1010) and Uppsala (n=999). The primary aim of the study is to evaluate prospectively the risk factors for osteoporosis and fractures. At baseline these men answered a questionnaire that evaluated fracture history and life style along with the occurrence of back pain, low back pain and sciatica during the preceding 12 months. They also had their total body, total hip and lumbar spine BMD measured by dual energy X-ray absorptiometry (DXA). Also 988 of the men in Malmö and 465 of the men in Gothenburg underwent a lateral thoracic and lumbar spine radiograph. Clinical and radiographically verified fractures that occurred after baseline were registered for a mean 10 years by repeated review of the archives of the respective radiographic departments.

This thesis shows that a prevalent vertebral fracture in elderly men is of low clinical relevance in respect of back pain, that lifestyle and social factors are associated with not only LBP but also LBP and SCI and that a prevalent vertebral fracture and especially those fractures with specific characteristics, could be used to identify individuals at high risk of having osteoporosis and sustaining new fractures.

Publishing year





Lund University Faculty of Medicine Doctoral Dissertation Series



Document type



Clinical and Molecular Osteoporosis Research Unit, Clinical Sciences, Malmö.


  • Orthopedics



Research group

  • Orthopedics - Clinical and Molecular Osteoporosis Research


  • ISSN: 1652-8220
  • ISBN: 978-91-7619-209-2

Defence date

27 November 2015

Defence time


Defence place

Lecture Hall, CRC, Malmö


  • Yohan Robinson