From the Guidelines
Osteoporosis itself typically does not cause pain until a fracture occurs, at which point the pain can be sudden, severe, and localized to the area of the fracture, most commonly in the spine, hip, or wrist. The type of pain caused by osteoporosis is often related to the location and severity of the fracture.
Common Types of Pain
- Vertebral fractures can cause acute back pain that may become chronic over time, as well as height loss, stooped posture (kyphosis), and chronic back pain due to multiple compression fractures and altered spine biomechanics 1.
- Hip fractures can cause significant pain in the groin or outer upper thigh.
- Wrist fractures can result in localized wrist and hand pain. The pain from osteoporotic fractures occurs because the weakened bones can break even with minimal trauma or normal activities like bending, lifting, or coughing 1.
Management of Pain
Pain management typically involves a combination of pain medications, physical therapy, and treating the underlying osteoporosis with medications like bisphosphonates, denosumab, or teriparatide to prevent further fractures, as noted in the management of osteoporosis with bisphosphonates 1. Early treatment of osteoporosis before fractures occur is ideal, as this can prevent the pain associated with bone breaks. In cases where fractures do occur, interventions such as vertebroplasty or kyphoplasty may be considered for refractory pain associated with vertebral compression fractures 1.
From the FDA Drug Label
In post-marketing experience, severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking bisphosphonates that are approved for the prevention and treatment of osteoporosis [see Adverse Reactions (6. 2)]. Atypical, low-energy, or low trauma fractures of the femoral shaft have been reported in bisphosphonate-treated patients... They may be bilateral and many patients report prodromal pain in the affected area, usually presenting as dull, aching thigh pain, weeks to months before a complete fracture occurs.
Osteoporosis itself does not directly cause pain, but bisphosphonates used to treat osteoporosis can cause:
- Bone pain
- Joint pain
- Muscle pain
- Dull, aching thigh pain (prodromal pain before a complete fracture occurs) 2
From the Research
Types of Pain Caused by Osteoporosis
- Osteoporotic fractures can cause acute and chronic pain, mainly affecting elderly patients with multiple comorbidities and commonly on different drug regimens 3, 4.
- The pain associated with osteoporosis can be characterized as nociceptive and neuropathic pain 3, 4, 5.
- Central sensitization seems to play a pivotal role in developing and maintaining chronicity of post-fracture pain in osteoporosis 3, 4.
Characteristics of Osteoporotic Pain
- Chronic pain after osteoporotic fractures requires a multifaceted approach, which includes a large spectrum of drugs and non-pharmacological treatment 3, 4.
- The management of chronic pain in patients with osteoporosis is complicated with regard to its diagnosis, the search for reversible secondary causes, and the efficacy and duration of treatment 5.
- Pain management must include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment 5.
Treatment of Osteoporotic Pain
- Antiosteoporosis drugs are able to partially control pain, but additional analgesics are always necessary for pain due to bone fractures 3, 4.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective COX-2 inhibitors reduce acute pain but with a poor effect on the chronic neuropathic component of pain and with relevant side effects 3, 4.
- Opioid drugs can control the whole spectrum of acute and chronic bone pain, but they differ with respect to their efficacy on neuropathic components, their tolerability and safety 3, 4.