Recently, the Chinese Geriatric Health Care Medical Research Association
Organizing expert of the Geriatric Pain Disease Branch
The "Diagnosis and Treatment of Osteoporotic Pain in the Elderly" was formulated
Management Expert Consensus (2024 Edition),
It aims to regulate and promote the elderly in the mainland
Clinical diagnosis and treatment of osteoporotic pain.
5 types of pain can be a sign of osteoporosis
Osteoporosis can be caused by a variety of factors, including genetics, immune factors, decreased levels of sex hormones and calcitonin, and increased corticosteroids.
Many patients often experience pain throughout their body before their height is significantly reduced. Here are five common types of pain that are often early warning signs of osteoporosis↓
01
Pain at night
People with osteoporosis often experience pain at night or early in the morning, which can be difficult to pinpoint and manifest as generalized malaise.
This discomfort may be related to the accumulation of micro-injuries from daytime activities, with pain being more pronounced at nighttime rest.
02
Low back pain
Osteoporosis can lead to significant changes in bone structure, and the lower back, shoulders and neck are prone to become the main areas of pain due to heavy weight bearing and activity.
The pain is worse during activity, especially after prolonged standing, sitting, or physical exertion.
03
Pain in the limbs
Osteoporosis can also cause pain in the extremities, especially when weight-bearing or activity. This pain can be related to muscle fatigue, joint inflammation, or pinched nerves.
Pain in the limbs without obvious trauma, especially at night or in the morning, can be a sign of osteoporosis. It may be due to vertebral fractures that compress the vertebral body and shrink the intervertebral foramen, which in turn compresses the spinal nerve roots, causing radiating pain in the extremities, which may be accompanied by sensory or motor disturbances in both lower extremities, intercostal neuralgia, retrosternal pain (similar to angina), and even epigastric pain (similar to an acute abdomen).
04
Chronic pain
People with osteoporosis may suffer from chronic pain for a long time, which can last for weeks, months, or even years. Chronic pain can be associated with ongoing destruction of bone microstructures, long-term muscle fatigue, or nerve damage.
Long-term unexplained chronic pain, especially in the absence of significant trauma or inflammation, can be an early sign of osteoporosis.
05
Acute pain
In patients with more severe osteoporosis, when a fracture occurs, severe acute pain will quickly appear in areas such as vertebral body and femoral neck, and the pain will be significantly aggravated when turning over, sitting up and other movements. This situation should be taken seriously and medical attention should be sought as soon as possible.
The above pain symptoms may overlap with each other, for example, low back pain can be either chronic or acute.
To summarize the pain characteristics of osteoporosis aims to raise public awareness of this type of pain so that early warning can be taken so that preventive measures or early treatment can be taken However, it is important to rule out the possibility of trauma or medical illness in the first place when pain is present. If it is difficult to self-judge, you should seek medical attention in time, and a professional doctor will diagnose and treat you.
02
What should I do if I have osteoporotic pain?
Middle-aged and elderly people with any of the above pain should go to the hospital for treatment in time. A thorough physical examination, bone densitometry, and other relevant imaging and laboratory tests can rule out an underlying acute condition and assess the severity of osteoporosis. Once the diagnosis is confirmed, patients should actively receive clinical treatment under the guidance of a doctor.
01
General treatment
General treatment focuses on lifestyle modifications. Patients with osteoporotic pain should maintain a balanced diet, enhance nutritional intake, ensure adequate sunlight, and exercise regularly.
In addition, quit smoking and limit alcohol, avoid excessive consumption of coffee and carbonated beverages, and reduce the use of drugs that affect bone metabolism. In addition, preventing falls and ensuring adequate intake of calcium and common vitamin D are key.
02
drug therapy
Drug treatment is divided into two categories: anti-osteoporotic drugs and analgesic drugs, which need to be used under the guidance of a professional doctor.
Anti-osteoporotic drugs
Bisphosphonates
Such as alendronate and risedronate, help reduce bone resorption and increase bone density.
Calcium and vitamin D supplementation
It is essential for bone health and is recommended to consume adequate daily amounts.
Calcitonin
May reduce pain and help maintain bone density.
Selective estrogen receptor modulators (SERMs)
Such as raloxifene, which is suitable for postmenopausal women.
Synthetic parathyroid hormone
For example, teriparatide is used in patients with severe osteoporosis.
Analgesic medications
非甾体抗炎药（NSAIDs）
Such as ibuprofen and naproxen, are used to relieve pain.
Opioids
For severe pain, short-term use may be required, but caution is needed to avoid addiction.
It is important to emphasize that drug therapy for osteoporosis needs to be individualized to the specific situation of the patient and may require a combination of multiple drugs. Therefore, patients diagnosed with osteoporosis must take medication under the guidance of a doctor, and do not treat it at will.
03
Interventional and surgical treatments
For osteoporotic vertebral compression fractures, early anti-osteoporotic therapy is essential to prevent recurrence.
For elderly patients with hip fractures, surgical treatment is recommended as soon as possible to promote recovery on the premise of excluding absolute contraindications to surgery.
04
Psychotherapy and exercise therapy
Psychotherapy: Cognitive behavioral therapy can effectively improve patients' self-control, deepen their understanding of pain, and stimulate positive coping strategies, so as to improve the subjective feelings of patients with chronic pain and improve their quality of life.
Exercise therapy: Exercises such as swimming, yoga, Pilates, etc., under the guidance of professionals, can significantly enhance muscle strength, body coordination and balance in elderly patients, thereby reducing the risk of falls.
For the elderly, walking is one of the easiest forms of exercise, and walking with appropriate weights is good for health, but the exercise intensity needs to be reasonably adjusted according to the individual's physical fitness.
03
Different age groups "raise bones" to do this
Osteoporosis is a disease that can be effectively prevented through early intervention and lifestyle modification, and prevention is far more important than cure.
Children & Adolescents (0~18 years old)
At this stage, the bones are in a period of rapid growth and development, and bone density continues to increase, mainly through the process of bone formation. Therefore, it is crucial to ensure healthy bone development and maximize bone density.
Dairy products, green leafy vegetables, and fortified foods are good sources of calcium, while sun exposure and vitamin D-rich foods (e.g., cod liver oil, egg yolks) help with vitamin D synthesis.
At the same time, it is important to increase physical activity, weight-bearing exercises such as running, skipping rope and ball games, as well as moderate strength training, can help promote healthy bone development and enhance bone density.
In addition, maintain a healthy lifestyle, reduce the intake of sugary drinks, and avoid smoking and exposure to secondhand smoke to maintain bone health.
Adults (19~45 years old)
At this stage, bone mass is usually maintained at a relatively stable level, and the process of bone formation and bone resorption is in a state of dynamic equilibrium. Therefore, maintaining bone health and preventing osteopenia is key.
Ongoing attention to nutrition is required to ensure adequate intake of protein, vitamins and minerals to maintain bone health. Get plenty of sun and exercise moderately. Sun exposure helps with vitamin D synthesis, while moderate exercise helps maintain bone density. At the same time, proper calcium supplementation and quitting smoking and alcohol restriction can help reduce bone loss and maintain bone health.
Middle-aged and elderly (45 years old and above)
As we age, bone resorption progressively outpaces bone formation, resulting in osteopenia and bone weakness, increasing the risk of osteoporosis and fractures. Therefore, it is particularly important to prevent osteoporosis and fractures.
At this stage, it is important to eat a balanced diet to ensure adequate intake of protein and other key nutrients. At the same time, doing the right amount of strength training can help maintain bone density and muscle mass. In addition, regular physical examinations, including bone density testing, are performed to allow for early detection and intervention of osteoporosis.
Oral medications may be considered for intervention if necessary. Lifestyle adjustments to ensure a safe living environment, such as the use of non-slip mats, handrails, etc., are also important preventive measures.
Editor: Li Ling
Source: Popular Science China
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