Pain-Related Determinants of Frailty in Osteoporotic Vertebral Compression Fractures.

PURPOSE: To investigate the prevalence and determinants of frailty, including pain, in patients with osteoporotic vertebral compression fracture (OVCF) and to elucidate the interrelationships among these factors using a structural equation modeling (SEM) approach.

DESIGN

Cross-sectional correlational study.

METHODS

From October 2024 to May 2025, 400 patients with OVCF were recruited from two tertiary hospitals in Zhejiang Province, China. Data were collected through self-administered questionnaires, including the visual analog scale (VAS) for pain, Tampa scale for kinesiophobia (TSK), self-rating scale of sleep (SRSS), and Tilburg Frailty Indicator (TFI). Descriptive statistics and SEM were used to examine relationships among variables.

RESULTS

A total of 368 participants were included. The prevalence of frailty was 68.2%. The SEM demonstrated good model fit (χ²/df = 1.802, RMSEA = 0.047). Pain had both direct effects on frailty (β = 0.321, p < .001) and indirect effects through kinesiophobia and sleep quality (β = 0.359, p < .001), yielding a total effect of 0.679. Kinesiophobia showed direct (β = 0.267, p < .001) and indirect (β = 0.072, p < .001) effects on frailty, with a total effect of 0.338. Poor sleep quality was also directly associated with frailty (β = 0.283, p < .001).

CONCLUSION

This study demonstrated that the incidence of frailty among patients with OVCF is relatively high and clarified the chain pathway "pain → fear of movement → sleep quality → frailty," highlighting mediating roles that provide a theoretical basis for targeted interventions to reduce frailty risk and promote recovery.