Osteoporotic pain is usually acute, of sudden onset, and caused by a fracture in the lower thoracic or lumbar vertebrae. On examination, there will be a painful spot in the area of the back where the vertebral fracture has occurred. The muscles next to the spine will be very tense and painful to touch. This pain can last for long periods ranging from a few weeks to months. In all patients, an X-ray of the affected skeletal area should be taken to demonstrate or rule out a vertebral fracture and to document the extent of destruction of bone. A bone scan may demonstrate an acute inflammation around an area of fractured bone and may therefore show fractured vertebrae long before a regular X-ray because of the increased uptake in that area. It has further been suggested that covert small fractures — microfractures — due to mechanical stress can also cause pain. When the intraosseous pressure exceeds a certain level, fluid in the bone enters the subperiosteal space, exercises pressure on the nerves, and induces a painful periosteal reaction. Pain during healing of a fracture may well be related to local release of cytokines, prostanoids, histamine, and bradykinin in the surrounding area.
KeywordsDepression Osteoporosis Histamine Prostaglandin Bisphosphonates
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