Barresi Giada, Oliveri Cecilia, Morabito Nunziata, Marini Herbert Ryan, Xourafa Anastasia, Gaudio Agostino, Martino Gabriella, Minutoli Letteria, Catalano Antonino
Department of Clinical and Experimental Medicine, University of Messina, Via C. Valeria, 98125, Messina, Italy.
Unit of Talassemia, University Hospital of Catania, Catania, Italy.
Drugs Aging. 2025 Jul 9. doi: 10.1007/s40266-025-01225-1.
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.
骨质疏松症是最常见的代谢性骨病，也是老年人骨折的主要原因。尽管它通常被描述为一种无声的疾病，但脆性骨折引起的骨痛是其主要症状。除了急性疼痛外，脆性骨折可能引发一系列事件，使疼痛持续并发展为慢性疼痛。骨质疏松症患者肌肉骨骼疼痛的发病机制复杂，很大程度上取决于骨骼和肌肉的变化、骨转换失衡、骨神经支配改变以及中枢敏化。在骨脆性的背景下，疼痛是导致功能受限、残疾和生活质量受损的一个突出因素。疼痛预防与骨质疏松症风险因素的识别以及骨脆性的早期诊断和治疗密切相关。重度骨质疏松症患者的疼痛管理也受益于非药物治疗与药物治疗相结合的多维方法（例如，适当进行体育锻炼、营养补充、使用镇痛药和抗骨质疏松药物）。本综述旨在探讨骨质疏松症疼痛的机制，并对当前和新兴的治疗策略提供基于证据的概述。
