Francis R M, Aspray T J, Hide G, Sutcliffe A M, Wilkinson P
School of Clinical Medical Sciences, University of Newcastle, Newcastle upon Tyne, UK.
Osteoporos Int. 2008 Jul;19(7):895-903. doi: 10.1007/s00198-007-0530-x. Epub 2007 Dec 11.
This review article examines the epidemiology and pathogenesis of back pain and vertebral fractures in osteoporosis, reviewing the management of pain in patients with vertebral fractures and the direct and indirect effect of osteoporosis treatments on back pain.
The management of patients with vertebral fractures has largely concentrated on the prevention of further fractures by the treatment of underlying osteoporosis, with drug treatment for acute and chronic back pain and the non-pharmacological management of vertebral fractures receiving less attention.
Emerging evidence suggests that, in addition to reducing the incidence of vertebral fractures, calcitonin, intravenous bisphosphonates and teriparatide may also have a direct effect on bone pain. Targeted analgesia, tailored to individual need is often required in both the acute and chronic phases following vertebral fracture. Vertebroplasty and kyphoplasty have also been approved for use in the management of vertebral fractures and may prove useful in selected patients unresponsive to conventional pain relief. There is some evidence to support the use of individualised tailored exercise programmes aimed at strengthening back muscles to maintain bone density and reduce further fracture incidence. In addition the use of specific orthoses may help to reduce kyphosis, improve mobility and reduce pain.
Chronic back pain associated with vertebral fracture provides a great challenge to health care professionals and the patient. This demands a combination of options, including not only therapeutic interventions, but also physiotherapy, psychological support and patient education.
这篇综述文章探讨了骨质疏松症中背痛和椎体骨折的流行病学及发病机制，回顾了椎体骨折患者疼痛的管理以及骨质疏松症治疗对背痛的直接和间接影响。
椎体骨折患者的管理主要集中于通过治疗潜在的骨质疏松症来预防进一步骨折，而针对急性和慢性背痛的药物治疗以及椎体骨折的非药物管理受到的关注较少。
新出现的证据表明，除了降低椎体骨折的发生率外，降钙素、静脉注射双膦酸盐和特立帕肽可能对骨痛也有直接影响。在椎体骨折后的急性期和慢性期，通常都需要根据个体需求进行有针对性的镇痛。椎体成形术和后凸成形术也已被批准用于椎体骨折的管理，对于某些对传统止痛方法无反应的患者可能有用。有一些证据支持使用旨在增强背部肌肉以维持骨密度和降低进一步骨折发生率的个体化定制运动方案。此外，使用特定的矫形器可能有助于减少脊柱后凸、改善活动能力并减轻疼痛。
与椎体骨折相关的慢性背痛给医护人员和患者带来了巨大挑战。这需要多种选择相结合，不仅包括治疗干预，还包括物理治疗、心理支持和患者教育。
