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Many people who have osteoporosis experience no pain at all until they start having fractures. Then they have pain all the time. Pain from fractures is not easy to manage, but there are ways to take back control over your life.

Osteoporosis can be acutely painful, but it almost always begins as a silent disease. It is driven in part by inflammation, but the intensity of this inflammation is so low that the condition isn't even noticed. Osteoporosis does not announce itself with the classic symptoms of inflammation: pain, heat, redness, and swelling.

Osteoporosis does not scream at you. Instead, it nags you with a variety of symptoms you may not be quite sure about. Joint pain that seems to come and go with no obvious cause is one of them. Skin sensitivity over an affected bone is another. Or muscles may not quite stretch over a demineralized joint. A classic early warning sign of osteoporosis of the hip is pain at the front of the leg that is relieved by flexing the leg at the knee and rolling the foot outward, as muscles don't quite stretch all the way over the hip joint. But sometimes stiffness, fatigue, depression, irritability, and generally feeling mad at the world are all you have to go on. These symptoms, of course, can point to many, many different diseases. Pain alone isn't a reliable symptom of osteoporosis. But once you know you have osteoporosis, you may be in for a world of pain.

What kinds of pain are common in osteoporosis?

Once osteoporosis causes one fracture, there is a high likelihood of another. Bone fractures in and of themselves are painful, but they often resolve in four to six weeks. The pain from the fracture stops, but the pain in the muscles that have to adjust to the new configuration of bone is ongoing.

Because of pain, people who have osteoporosis tend to be sedentary. When they don't get exercise, bone does not get important signals to rebuild itself. Loss of bone minerals accelerates, and even when there aren't any fractures, there can be new damage to bone. There can be problems with balance, which leads to falls and still more fractures. After a few years, people who have osteoporosis can be in intractable, continuous pain. A fracture may continue to be painful even after it has healed.

Lower back pain is common in osteoporosis. The frequency of pain in osteoporosis increases with age. One survey found that continuous pain is a problem for 41 percent of people who have osteoporosis aged 65–75 years, 48 percent of people who have osteoporosis aged 75–84 years, and 55 percent of people who have osteoporosis who are 85 or older.

Medication for the pain of osteoporosis usually does not work

In many countries, it is hard to get access to pain relief. Some countries ban opioid pain relievers altogether. Some states in the United States, Texas, for example, effectively require people who are in pain to make a trip to the pharmacy in person every two to three days to get up to 10 pills to control pain. And even where there is reasonable access to medications for drugs, there are predictable problems:

  • NSAID pain relievers such as aspirin and Tylenol are offered for "mild" pain, up to a three on a standard pain scale. However, this class of pain relievers may interfere with the production of collagen, which holds the minerals of bone together.
  • NSAIDs plus opioids, such as acetaminophen with codeine, offers relief for "moderate" pain, four to six on a standard pain scale. However, many governments strictly regulate even these relatively mild pain relievers, and they can cause constipation (which becomes painful when it is necessary to strain to pass stool) and stomach upset. Even low-dose opioids can cause  itching, burping, belching, bloating, or sedation, and some users build up a tolerance to the opioid so that higher and higher doses are required to get any level of pain relief.
  • Opioids plus "adjuvant" pain relievers are offered for severe pain. These pain relievers always require close medical supervision.
About 50 percent of people on any kind of pain medicine experience at least one serious side effect, which may include a fall that causes new fractures. About 20 percent of people on any kind of pain medicine give up before they finish the prescription. So what else is there?

Other approaches to managing the pain of osteoporosis

Pain medications are not the only way to manage the pain of osteoporosis. There are some remarkably simple interventions for pain that usually help.

  • Vitamin D influences the pathways that convey pain signals to the brain. It seems to help the central nervous system "organize" as response to bone pain that reduces discomfort. It relieves muscle pain and, as is well known, helps bones absorb calcium. It is possible to overdose vitamin D. Taking 50,000 IU or more can actually make bone pain worse. However, 1000 to 5000 IU of vitamin D3 every day usually relieves some of the pain in the muscles that lingers after fractures heal.
  • Low-frequency PEMFs (pulsed electromagnetic fields) often relieve pain quickly. These are not magnets like refrigerator magnets. These are magnets that deliver pulsed magnetic fields, usually through a headband. Their effect is on the brain, not the bone (although there are magnetic devices for healing bones). In a few countries, notably Sweden and Switzerland, PEMF therapy is approved and may even be covered by insurance. However, in most of the world, it is necessary to invest in your own treatment device, usually at a cost of US $600 to $1000.
  • Vibration training "shakes your pain away." You stand on a platform that gently vibrates your entire body to "distract" your brain from pain and to stimulate the building of bone. There have been at least 12 studies of vibration therapy for older women who have osteoporosis. Vibration has been found to improve biomarkers of bone health such as sclerostin, the bone alkaline phosphatase, N-telopeptide X and 25-hydroxyvitamin D. Vibration training is available at some gyms and bone clinics. The vibration platforms usually cost several thousand (US) dollars. It is important to begin vibration training at a gentle frequency under experienced supervision.
  • Exercise relieves pain, but it is important to avoid twisting the trunk of the body. "Core" training has to be done very carefully. Clinical trials have confirmed that Pilates increases bone mineralization, improves pain-free walking distance. and generally improves quaility of life. Qigong (Wuqinxi) may relieve pain if practiced for six months or more. Yoga classes, even seated yoga, generally help to relieve pain and provide a social outlet. Almost any exercise that focuses on good posture and mindful movement helps relieve the pain of osteoporosis.
Still looking for pain relief for osteoporosis? Doctors who specialize in osteoporosis may offer bisphosphonates, stronium ranelate infusions, teriparatide (recombinant human parathyroid hormone), calcitonin, and immunotherapy drugs such as denosumab. Sometimes surgical joint replacement is the answer. Just don't give up. Most people who persist with medical treatment of osteoporosis eventually find satisfactory pain control.

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  • Photo courtesy of SteadyHealth

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