Bone pain mechanism in osteoporosis: a narrative review

Abstract

SummaryBone pain in elderly people dramatically affects their quality of life, with osteoporosis being the leading cause of skeletal related events. Peripheral and central mechanisms are involved in the pathogenesis of the nervous system sensitization. Osteoporosis in the elderly has been associated with increased density of bone sensory nerve fibers and their pathological modifications, together with an over-expression of nociceptors sensitized by the lowering pH due to the osteoclastic activity. The activation of Nmethyl-D-aspartate (NMDA) receptors and the microglia, as a response to a range of pathological conditions, represent the leading cause of central sensitization. Unfortunately, osteoporosis is named the "silent thief" because it manifests with painful manifestation only when a fracture occurs. In the management of patients suffering from bone pain, both the nociceptive and the neuropathic component of chronic pain should be considered in the selection of the analgesic treatment.

Bone morbidity in pediatric acute lymphoblastic leukemia

“…Bone pain mainly occurs due to uncontrolled osteoclastic activity causing altered sympathetic nerve fiber regulation and neuropeptide release. 13,14) Periosteal reaction (<19%), low bone mass (<40%), and fractures (<10%) are consecutive results due to infiltration of leukemic cells in bone. 9)…”

Cannabinoid receptors in osteoporosis and osteoporotic pain: a narrative update of review

“…Chronic pain is one of the most important complications of osteoporosis and is a challenging management for clinicians . In addition to the direct effects of resulting fracture which can cause acute and chronic nociceptive and neuropathic pain, pain is also a common feature in osteoporosis without fracture .…”

“…It has been reported that postmenopausal women have significant higher prevalence of low back pain and there is an association of repetitive pain with regional migratory osteoporosis (RMO) . Central sensitization has been suggested to play an important role in the development and maintenance of chronic pain related with osteoporotic fracture which is difficult for treatment and usually requires a comprehensive strategy including a large spectrum of drugs and non‐pharmacological treatments …”

“…Chronic pain is one of the most important complications of osteoporosis and is a challenging management for clinicians. [22,23] In addition to the direct effects of resulting fracture which can cause acute and chronic nociceptive and neuropathic pain, [24] pain is also a common feature in osteoporosis without fracture. [3] It has been reported that postmenopausal women have significant higher prevalence of low back pain [25] and there is an association of repetitive pain with regional migratory osteoporosis (RMO).…”

“…[26] Central sensitization has been suggested to play an important role in the development and maintenance of chronic pain related with osteoporotic fracture which is difficult for treatment and usually requires a comprehensive strategy including a large spectrum of drugs and non-pharmacological treatments. [23,27] The EC system has been implicated in pain modulation [7,8] and may be involved in the osteoporotic pain as the EC system is involved in the pathology of osteoporosis as mentioned above. In fact, it is found that activation of CB2 receptor by agonists JWH015 could via cytokine/chemokine suppression reduce breast cancer-induced bone loss and severe bone pain induced by implanting the spontaneously occurring murine mammary cell line (66.1) into the femur intramedullary space.…”