Osteoporosis Pain

Introduction

In some patients, the first sign of osteoporosis is an episode of acute back pain that occurs when a patient is participating in a routine activity. The pain typically intensifies with sitting or standing, is relieved by bed rest, and is exacerbated by sudden movements (e.g., coughing, sneezing, turning quickly). After the acute phase has passed, the patient may experience persistent back pain. Postmenopausal women and patients treated with glucocorticoids are at increased risk for osteoporosis, the most common complication of which is vertebral compression fractures. Of the approximately 750,000 vertebral compression fractures that occur in the U.S. each year, about one-third are clinically painful.²³

The persistent pain of vertebral compression fractures may be due to vertebral deformity, paraspinous muscle spasm and/or degenerative changes. Persistent pain may also be an indirect consequence of multiple vertebral compression fractures resulting in kyphosis (Dowager’s hump).²⁴ Kyphosis may cause back muscles and ligaments to become extended beyond a normal position, leading to postural pain. The persistent pain of osteoporosis is deep and aching in quality. The location of the pain is dependent on the location of the vertebral compression fractures, which can be confirmed radiographically. Pain is exacerbated by weight bearing, by Valsalva maneuvers, lifting and bending, and there is often tenderness to percussion. The neurological examination is usually normal.