Pain in Osteoporosis: Current and Future Strategies

Osteoporosis is the most common metabolic bone disease and the main cause of fractures in older adults. Although it is commonly described as a silent disease, the bone pain caused by fragility fractures is its main symptom. Besides acute pain, fragility fractures may trigger a sequence of events that perpetuate and progress into chronic pain. The pathogenesis of musculoskeletal pain in patients with osteoporosis is complex and largely depends on skeletal and muscular changes, unbalanced bone turn-over, alterations in bone innervation, and central sensitization. Pain, in the context of bone fragility, represents an outstanding contributor to functional limitation, disability, and impaired quality of life. Pain prevention is closely related to identification of osteoporosis risk factors and early diagnosis and treatment of bone fragility. The management of pain in patients with severe osteoporosis also benefits from a multidimensional approach combining nonpharmacological with pharmacological therapies (e.g., physical exercise, nutrition, analgesics, and anti-osteoporotic drugs, as appropriate). This review aims to examine the mechanisms of pain in osteoporosis and provide an evidence-based overview of current and emerging treatment strategies.