Analgesic Effects of Antiosteoporotic Drugs (골다공증 치료 약제의 통증조절 효과)

안동기; 신원식; Go We Kim (김고위)

Analgesic Effects of Antiosteoporotic Drugs

Journal of Korean Society of Spine Surgery
Abbr : J Kor Spine Sur
2017, 24(1), pp.59-64
Publisher : Korean Society Of Spine Surgery
Research Area : Medicine and Pharmacy > Orthopedic Surgery

안동기 ¹, 신원식 ², Go We Kim ³

¹서울성심병원 정형외과
²서울성심병원정형외과학교실
³서울성심병원

Accredited

ABSTRACT

Study design: Literature review. Objectives: To propose possible mechanisms of osteoporotic back pain and its management with antiosteoporotic drugs. Summary of Literature Review: No general conclusion has yet been reached regarding whether osteoporosis without fractures can cause pain. Instead, only treatments for back pain without osteoporotic spine fractures have been reviewed in the previous literature. Although key studies of antiosteoporotic drugs have not investigated their analgesic efficacy, plausible mechanisms have been suggested. Materials and Methods: The analgesic effects of antiosteoporotic agents available in Korea were reviewed. Results: Rather than the long-term use of conventional analgesics or narcotics, antiosteoporotic drugs would be more beneficial because they can enhance bone strength and have fewer side effects. Both anabolic and antiresorptive agents available in Korea have been proven to have an analgesic effect against osteoporotic back pain, with or without fractures. Anabolic agents depend on skeletal effects. Among antiresorptive agents, bisphosphonates have both skeletal and extraskeletal mechanisms for analgesia. Calcitonin and selective estrogen receptor modulators mostly depend on extraskeletal effects. The order of analgesic strength for osteoporotic back pain is teriparatide > bisphosphonate > calcitonin. This implies that the analgesic effect of antiosteoporotic drugs primarily depends on their skeletal effects rather than on their extraskeletal effects. Moreover, because non-fracture osteoporotic pain has been recognized only in the spine, where fractures can occur without a sensible injury, pain may arise from undiscovered spine fractures. Conclusions: Antiosteoporotic drugs ameliorate osteoporotic back pain. Their analgesic strength is proportional to their fracture prevention efficacy.

KEYWORDS

Key words: Osteoporotic pain, Analgesic effect, Anti-osteoporotic drugs

Citation status

* References for papers published after 2023 are currently being built.

[journal] Muraki S / 2009 / Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts : the ROAD study / Osteoarthritis Cartilage 17 : 1137~1143

[journal] Edwards RR / 2003 / Age-related differences in endogenous pain modulation : a comparison of diffuse noxious inhibitory controls in healthy older and younger adults / Pain 101 : 155~165

[journal] Cole LJ / 2010 / Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure / Neurobiol Aging 31 : 494~503

[journal] Jimenez-Andrade JM / 2012 / The effect of aging on the density of the sensory nerve fiber innervation of bone and acute skeletal pain / Neurobiol Aging 33 : 921~932

[journal] Gaus S / 2003 / Capsaicin treatment inhibits osteopenia and heat hyperalgesia induced by chronic constriction injury to the sciatic nerve in rats / Hiroshima J Med Sci 52 : 43~51

[journal] Nagae M / 2006 / Osteoclasts play a part in pain due to the inflammation adjacent to bone / Bone 39 : 1107~1115

[journal] Rogers MJ / 2011 / Biochemical and molecular mechanisms of action of bisphosphonates / Bone 49 : 34~41

[journal] Iwamoto J / 2004 / Effects of alendronate on metacarpal and lumbar bone mineral density, bone resorption, and chronic back pain in postmenopausal women with osteoporosis / Clin Rheumatol 23 : 383~389

[journal] Corrado A / 2007 / Extra-skeletal effects of bisphosphonates / Joint Bone Spine 74 : 32~38

[journal] Ceponis A / 2001 / Effects of lowdose, noncytotoxic, intraarticular liposomal clodronate on development of erosions and proteoglycan loss in established antigen-induced arthritis in rabbits / Arthritis Rheum 44 : 1908~1916

[journal] Kim S / 2013 / Analgesic effects of the non-nitrogen-containing bisphosphonates etidronate and clodronate, independent of anti-resorptive effects on bone / Eur J Pharmacol 699 : 14~22

[journal] Fujita T / 2009 / Comparison of the analgesic effects of bisphosphonates : etidronate, alendronate and risedronate by electroalgometry utilizing the fall of skin impedance / J Bone Miner Metab 27 : 234~239

[journal] Pappagallo M / 2014 / A pilot trial of intravenous pamidronate for chronic low back pain / Pain 155 : 108~117

[journal] Pappagallo M / 2003 / Treatment of chronic mechanical spinal pain with intravenous pamidronate : a review of medical records / J Pain Symptom Manage 26 : 678~683

[journal] Ohtori S / 2010 / Risedronate decreases bone resorption and improves low back pain in postmenopausal osteoporosis patients without vertebral fractures / J Clin Neurosci 17 : 209~213

[journal] Bonabello A / 2003 / Longterm analgesic effect of clodronate in rodents / Bone 33 : 567~574

[journal] Iolascon G / 2012 / Effectiveness of teriparatide treatment on back pain-related functional limitations in individuals affected by severe osteoporosis : a prospective pilot study / Clin Cases Miner Bone Metab 9 : 161~165

[journal] Ritchie RO / 2010 / How does human bone resist fracture? / Ann N Y Acad Sci 1192 : 72~80

[journal] Hadji P / 2012 / The effect of teriparatide compared with risedronate on reduction of back pain in postmenopausal women with osteoporotic vertebral fractures / Osteoporos Int 23 : 2141~2150

[journal] Dobolyi A / 2002 / Anatomical and physiological evidence for involvement of tuberoinfundibular peptide of 39 residues in nociception / Proc Natl Acad Sci U S A 99 : 1651~1656

[journal] Chhabra H / 2015 / An observational study to assess back pain in patients with severe osteoporosis treated with teriparatide versus antiresorptives : An Indian subpopulation analysis / Indian J Endocrinol Metab 19 : 483~490

[journal] Fischer JA / 1981 / Calcitonin : regional distribution of the hormone and its binding sites in the human brain and pituitary / Proc Natl Acad Sci U S A 78 : 7801~7805

[journal] Lyritis GP / 1999 / Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osteoporotic vertebral crush fractures : a prospective double-blind, randomized, placebo-controlled clinical study / Clin J Pain 15 : 284~289

[journal] Overman RA / 2013 / Salmon calcitonin use and associated cancer risk / Ann Pharmacother 47 : 1675~1684

[journal] Musgrave DS / 2001 / Back problems among postmenopausal women taking estrogen replacement therapy : the study of osteoporotic fractures / Spine (Phila Pa 1976) 26 : 1606~1612

[journal] Scharla S / 2006 / Skeletal pain in postmenopausal women with osteoporosis : prevalence and course during raloxifene treatment in a prospective observational study of 6 months duration / Curr Med Res Opin 22 : 2393~2402

[journal] Gennari C / 1986 / Migraine prophylaxis with salmon calcitonin : a cross-over doubleblind, placebo-controlled study / Headache 26 : 13~16

[journal] Micieli G / 1988 / Effectiveness of salmon calcitonin nasal spray preparation in migraine treatment / Headache 28 : 196~200

[journal] Iwamoto J / 2011 / Alendronate is more effective than elcatonin in improving pain and quality of life in postmenopausal women with osteoporosis / Osteoporos Int 22 : 2735~2742

[journal] Songpatanasilp T / 2014 / Back pain in patients with severe osteoporosis on teriparatide or antiresorptives : a prospective observational study in a multiethnic population / Singapore Med J 55 : 493~501

KJCKorea
Journal Central

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03