Korean J Spine Search


Pain Management for Osteoporosis
Sang-Dae Kim, M.D., Jung-Yul Park, M.D.
Department of Neurosurgery, College of Medicine, Korea University, Korea
골다공증의 통증 치료
고려대학교 의과대학 신경외과학교실
Osteoporosis is a skeletal condition characterized by decreased density(mass/volume) of normally mineralized bone. Postme- nopausal osteoporosis(Type I) and age-related osteoporosis(Type II) are the most common primary forms of bone loss seen in clinical practice. Secondary causes of osteoporosis include hypercortisolism, hyperthyroidism, hyperparathyroidism, alcohol abuse, and immobilization. In the development of osteoporosis, there is often a long latent period before the appearance of the main clinical manifestation, the pain and pathologic fractures. The development of pain associated with osteoporosis may differ patient to patient with regards to the degrees and natures of pain as well as temporal relations.
The earliest symptom of osteoporosis is often an episode of acute back pain that are non-specific or vague in nature but may be associated with vertebral compression fracture, or an episode of groin or thigh pain caused by hip fracture. In the diagnostic process, the extent and severity of bone loss are evaluated and secondary forms of bone loss must be excluded.
A careful diagnostic work-up that includes clinical history, physical examination, laboratory evaluation, bone densitometry, and radiographic imaging will allow the clinician to determine the cause of osteoporosis and to institute medical interventions that will stabilize and even reverse this frequently preventable condition.
The therapeutic strategies for treating osteoporosis associated with pain are designed to maximize peak bone mass through proper nutrition, appropriate intake of calcium and vitamin D, maintenance of physiologic menstrual cycles, program of weight bearing and strengthening exercises, and medications that may provide pain relief when present. Recently, vertebroplasty or kyphoplasty have shown to provide rapid pain relief, stability and functional restoration in osteoporotic vertebral compression fractures. However, judicious use is recommended due to potential risks and side effects(e.g., leakage and thermogenic injury). Therefore, factors such as benefit-risk and cost-effectiveness must be carefully considered, especially in whom such treatment is not strongly indicated or when pain persists after vertebroplasty, when choosing a therapeutic option for these painful, disabling patients.
Keywords: Osteoporosis.Compression fracture.Pain.Therapeutic option

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