Many people with osteoporosis are told by their doctors that the condition does not cause pain. It is true that osteoporosis does not directly cause pain as the bones become thinner. However, painful fractures, the compression of nerves, and muscle spasms can result from the effects of osteoporosis. Unfortunately, these indirect symptoms of osteoporosis can cause intense pain that may develop into debilitating chronic pain.

How Does Osteoporosis Lead to Pain?

Osteoporosis can lead to pain in many different ways.

• In most people, fractures cause pain for six to eight weeks after they occur. However, bone growth is slower in people with osteoporosis, and healing may take longer.
• Hip fractures usually result in chronic pain.
• As the vertebrae (bones of the spine) fracture, the spinal column collapses, causing chronic back and neck pain.
• Nerve roots can become compressed by the collapse of the spine, causing sciatica (pain that shoots through the hip or buttock and down the leg) and other nerve pain.
• Muscles can spasm, cramp, and pinch nerves as they contract to try to protect fragile joints and bones.
• Microscopic fractures can lead to deep bone pain that some people with osteoporosis describe as feeling like a toothache.
• Some researchers theorize that the process of bone erosion may contribute to inflammation, which increases pain around bones and joints.

People with osteoporosis can also experience pain that is caused by another condition, either one that is related to their osteoporosis or separate and unrelated. Identifying the origin of the pain is the first step in effectively treating it.

Conditions That Can Cause Pain and Secondary Osteoporosis

In people with secondary osteoporosis, osteoporosis is itself caused by another, primary condition or by a medication or radiation treatment. Some of these primary conditions can cause pain. Painful conditions that can cause secondary osteoporosis include:

• Chronic obstructive pulmonary disease (COPD) – Chest and shoulder pain
• Type 2 diabetes – Nerve pain in the hands, feet, arms, and legs
• Leukemia – Bone and joint pain
• Liver disease – Back, abdominal, or right shoulder pain
• Multiple myeloma – Bone pain
• Multiple sclerosis – Nerve pain and muscle spasms
• Rheumatoid arthritis – Swelling and inflammation in joints

Fibromyalgia, which causes widespread chronic pain and fatigue, is also theorized to raise the risk for developing osteoporosis.

In people with secondary osteoporosis, getting effective treatment for the primary condition may help reduce overall pain.

Pain Caused By Unrelated Conditions

People with osteoporosis can also experience pain caused or worsened by another, unrelated condition. Having more than one condition makes it more difficult for doctors to diagnose the true source of the pain, but identifying the cause of the pain is necessary for effective treatment.

Other causes of back, neck, or hip pain can include:

• Spondylosis – Normal degeneration of the spine that happens with age
• Spondylitis – Autoimmune condition causing inflammation of the back, neck, and hips and fusing of vertebrae
• Degenerative disc disease – Damage to the discs between vertebrae
• Herniated disc – Leakage of gel-like material that fills the discs
• Osteoarthritis – Deterioration of cartilage that cushions joints (read more in the FAQ below)
• Cervical stenosis – Narrowing of the spinal canal or the openings through which spinal nerves pass
• Spinal tumor

Pain as a Side Effect of Osteoporosis Medication

Some people experience pain as a side effect of treatment for osteoporosis. Back pain and pain in the bones, muscles, or joints are common side effects of Prolia (Denosumab). However, studies show that after 12 months of taking Prolia, bone pain improves in most people.

Treatments for Pain Related to Osteoporosis

Several osteoporosis medications have been proven in studies to improve pain as well as slowing the loss of bone density. These include bisphosphonates such as Actonel (Risedronate), Fosamax (Alendronate), and Boniva (Ibandronate); Calcitonin, sold under the brand names Fortical and Miacalcin; and Forteo (Teriparatide).

Many people treat pain related to osteoporosis with nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen or Naproxen.

People with severe pain not controlled by NSAIDs may require opioids such as Ultram (Tramodol) or Hydrocodone, sold as Norco and Vicodin.

Some antidepressants such as Elavil (Amitriptyline), Lexapro (Escitalopram), Savella (Milnacipran), Pamelor (Nortriptyline), and Effexor (Venlafaxine) have been shown to help manage neuropathic (nerve-related) pain.

In those with pain that is poorly controlled with medication, nerve ablation procedures that block or destroy nerves that send pain messages may be effective.

Vertebroplasty and kyphoplasty are two types of spinal surgery performed to stabilize spinal fractures. These procedures can stabilize the spine, preventing friction and further collapse.

Exercise and mind-body practices such as cognitive-behavioral therapy and mindfulness have been shown to improve chronic pain levels in those with osteoporosis.

External Resources

• Pain – Osteoporosis Canada
• Osteoclasts play a part in pain due to the inflammation adjacent to bone. – Bone
• Facts and Statistics – International Osteoporosis Foundatio
• Bone mineral density is decreased in fibromyalgia syndrome: a systematic review and meta-analysis – Rheumatology International
• Osteoarthritis – Mayo Clinic
• Osteoarthritis and Osteoporosis: What Is the Overlap? (PDF) – Current Rheumatology Reports
• Osteoporosis and Arthritis: Two Common but Different Conditions – National Institute of Arthritis and Musculoskeletal and Skin Diseases
• Neck Pain Causes – Spine-health
• Osteoporosis Treatment and Pain Management – SpineUniverse
• Management of chronic pain in osteoporosis: challenges and solutions – Journal of Pain Research
• Pain, Pain, Go Away: Antidepressants and Pain Management – Psychiatry

Conversations on MyOsteoporosisTeam

• Managing Pain and Osteoporosis (blog post)
• Stiff Joints and Osteoporosis (blog post)
• Neck pain and muscle spasms. Anyone else get these symptoms? (Q+A)
• Whoosh of pain in lower back and legs. Legs are weak and heavy. Any advice? (Q+A)

FAQ

What is the difference between osteoporosis and osteoarthritis?
Osteoporosis and osteoarthritis are separate, unrelated conditions. Both osteoarthritis and osteoporosis are very common conditions in older people, and both can lead to back and hip pain. Women have a higher risk than men for developing either osteoporosis or osteoarthritis.

Osteoporosis is the loss of bone density that leads to fractures. Many aspects of health, including hereditary and environmental factors, contribute to the development of osteoporosis. In some people, osteoporosis is caused by another medical condition or a medication. Osteoporosis is more likely to develop in thinner people with smaller frames. Being obese is a protective factor against developing osteoporosis, possibly because bone mineral density is greater in larger people. Osteoporosis may not be noticed until the first fracture occurs. Osteoporosis is diagnosed with a bone mineral density scan.

Osteoarthritis is a painful condition that develops when the cartilage that pads the joints is eroded by many years of heavy usage, such as manual labor or playing sports. Osteoarthritis is more likely to develop in people with larger frames who are carrying extra weight. Osteoarthritis is diagnosed with imaging scans such as X-rays or magnetic resonance imaging (MRI) that show joint damage.

Some studies have indicated that it is uncommon to have both osteoporosis and osteoarthritis. However, it is possible to have both conditions. If you think you may have osteoarthritis in addition to osteoporosis, talk to your doctor.