The Pain of Osteoporosis: It May Not be From a Fracture

Pam Flores @phflores Health Guide
  • We’re told osteoporosis is a silent disease, and for the most part it is, until we have a fracture.


    When we’re diagnosed with osteoporosis we also go through tremendous emotional pain, which is normal with most medical disease diagnoses.  Another cause of pain during bone loss is from the very treatment for this problem.

    The Food and Drug Administration (FDA) warns us that the bisphosphonates, used for bone loss, cause bone, joint and muscle pain.  The bisphosphonates include, Reclast®, Actonel®, Boniva® and Fosamax®.


    Prolia, a monoclonal antibody, used for osteoporosis treatment can also cause the same pain that the bisphosphonates can.  This treatment is administered twice yearly in an injection, done at a doctor’s office or clinic, and the side effects for this drug are very similar to the bisphosphonates above.  

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    Forteo, a daily injection of genetically engineered parathyroid hormone, can be used to treat the pain of fractures and jaw pain associated with osteonecrosis of the jaw (ONJ).


    Calcitonin nasal spray and injectable may be prescribed after fracture surgery to help treat the post-surgical pain.  It is also used prior to surgery when repairing a fracture for dual reasons of pain control and to stimulate bone growth before a surgery is undertaken for fracture of the spine or hip.


    Evista is a Selective Estrogen-Receptor Modulator (SERM), that binds with estrogen and cam mimic its action, as well as having an anti-estrogen action in some parts of the body and tissues.  This medication is used to treat osteoporosis and may have some side effects of muscle and joint pain.  Blood clots are the main side effect with this medication, which can cause muscle cramping and pain.


    Most of us would be quite surprised that these drugs for bone loss could be the cause of many types of pain.  Luckily, this doesn’t occur to everyone taking these medications, in fact some don’t experience this at all, but the FDA has these pain warnings on all the prescription labels, for these drugs, and requires the manufacturer to include this information in the prescribing information and on all drug labeling.


    While watching T.V., you may see the advertisements for these osteoporosis drugs and note the long list of pain warnings on some of these medications that are in the direct to consumer marketing program (DTC), for patient education.  You’ll notice their warning about renal failure, bisphosphonate-induced osteonecrosis of the jaw, femur fractures and a variety of different types of pain from taking these medications.  So be sure to document and treat these problems immediately and have your physician file an Adverse Event Report with the FDA.


    For the most part, these side effects only occur to some patients.  However, we need to be aware of the possibility so these types of pain can be treated correctly. 


    For more information on the FDA labeling on these drugs, see the Risk Evaluation and Mitigation Strategy (REMS) at the Food and Drug Administration for osteoporosis treatment.


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    September is Pain Awarness Month so check out our other fantastic articles on pain.


Published On: September 25, 2012