Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Back pain and osteoporosis

Full Text:


The aging process is accompanied by a structural change and a decrease in the functional activity of organs and tissues, including the bone, with the development of osteoporosis (OP).

Objective: to assess the characteristics of pain syndrome in OP patients with nonspecific chronic vertebrogenic lumbar ischialgia (CLI).

Patients and methods. Sixty elderly patients with CLI in the presence and absence of OP were examined. All the patients underwent dual-energy X-ray absorptiometry and ultrasound to diagnose the degree of OP and spinal deformity; a flexible rod was used according to the method described by M.A. Kathleen to estimate the angle of kyphosis, lordosis, and scoliosis. The investigators determined pain intensity by a numerical rating scale, the presence of a neuropathic pain component by the DN4 pain scale, the level of anxiety and depression by the Hospital Anxiety and Depression Scale, cognitive status by the Montreal Cognitive Function Rating Scale, the degree of disability by the Oswestry questionnaire, and quality of life by the SF-12 Health Survey.

Results and discussion. Our study showed that OP alone is not a cause of CLI in elderly patients. There were no statistically significant differences in the sources and intensity of pain, the degree of anxiety and depressive disorders, impaired quality of life, cognitive status, and degree of disability in patients with chronic lumbar pain syndrome in the presence and absence of OP. Vertebral deformity resulting from OP leads mainly to an obvious poor posture with an increase in thoracic kyphosis, straightening of lumbar lordosis, and S-curve lumbar and thoracic scoliosis, which can also cause secondary muscle spasm.

Patients with back pain in the presence of OP are treated in accordance with the general principles of management of patients with non-specific back pain, but taking into account the underlying disease. The paper presents current recommendations for the treatment of nonspecific back pain, for the management of patients with OP, as well as the updated clinical recommendations for the prevention of fractures in OP and osteopenia.

Conclusion. Patients with OP are noted to have predominantly chronic musculoskeletal pain in the presence of severe spinal deformity, but the level of this evidence is very low. The features of pain syndrome in patients with nonspecific vertebrogenic chronic lumbar ischialgia in the presence of OP call for further investigations. 

About the Authors

A. I. Isaikin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Department of Nervous System Diseases and Neurosurgery, 

11, Rossolimo St., Build. 1, Moscow 119021

O. Yu. Isaikina
National Medical Research Center for Preventive Medicine, Ministry of Health of Russia
Russian Federation
10, Petroverigsky Lane, Build. 3, Moscow 101990

T. I. Shadyzheva
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Department of Nervous System Diseases and Neurosurgery, 

11, Rossolimo St., Build. 1, Moscow 119021

Yu. M. Shor
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Department of Nervous System Diseases and Neurosurgery, 

11, Rossolimo St., Build. 1, Moscow 119021

M. S. Kachanovsky
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Department of Nervous System Diseases and Neurosurgery, 

11, Rossolimo St., Build. 1, Moscow 119021


1. Podichetty VK, Mazanec DJ, Biscup RS. Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J. 2003 Nov;79(937):627-33. doi: 10.1136/pmj.79.937.627.

2. Edmond SL, Felson DT. Prevalence of back symptoms in elders. J Rheumatol. 2000 Jan; 27(1):220-5.

3. Later Life in the United Kingdom. 2018. Factsheets /Later Life UK factsheet.pdf.

4. Parfenov VA, Isaikin AI. Bol' v nizhnei chasti spiny: mify i real'nost' [Low back pain: myths and reality]. Moscow: IMA-PRESS; 2016. P. 84-9.

5. van Tulder M, Becker A, Trudy B, et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006 Mar;15 Suppl 2: S169-91.

6. Enthoven WT, Geuze J, Scheele J. Prevalence and «Red Flags» Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice. Phys Ther. 2016 Mar;96(3):305-12. doi: 10.2522/ptj.20140525. Epub 2015 Jul 16

7. Wong AY, Karppinen J, Samartzis D, et al. Low back pain in older adults: risk factors,management options and future directions. Scoliosis Spinal Disord. 2017 Apr 18;12:14. doi: 10.1186/ s13013-017-0121-3. eCollection 2017.

8. Kherad M, Rosengren BE, Hasserius R, et al. Risk factors for low back pain and sciatica in elderly men-the MrOS Sweden study. Age Ageing. 2017 Jan 8;46(1):64-71. doi: 10.1093/ageing/afw152.

9. Mel'nichenko GA, Belaya ZhE, Rozhinskaya LYa, et al. Federal guidelines for the diagnosis, treatment and prevention of osteoporosis. Problemy endokrinologii. 2017;(6):392-426. (In Russ.).

10. Paolucci T, Saraceni VM, Piccinini G. Management of chronic pain in osteoporosis: challenges and solutions. J Pain Res. 2016 Apr 1;9:177-86. doi: 10.2147/JPR.S83574. eCollection 2016.

11. Nakamura T. Low Back Pain Accompanying Osteoporosis. JMAJ. 2003;46(10):445-51.

12. Fujimoto K, Inage K, Orita S. The nature of osteoporotic low back pain without acute vertebral fracture: A prospective multicenter study on the analgesic effect of monthly minodronic acid hydrate. J Orthop Sci. 2017 Jul;22(4): 613-617. doi: 10.1016/j.jos.2017.01.022. Epub 2017 Mar 9

13. Hoozemans MJ, Koppes LL, Twisk JW, van Dieёn JH. Lumbar bone mass predicts low back pain in males. Spine (Phila Pa 1976). 2012 Aug 15;37(18):1579-85. doi: 10.1097/BRS.0b013e31825409d8

14. Lee S, Nam CM, Yoon DH, et al. Association between low-back pain and lumbar spine bone density: a population-based crosssectional study. J Neurosurg Spine. 2013 Sep; 19(3):307-13. doi: 10.3171/2013.5.SPINE12473. Epub 2013 Jul 5.

15. Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (UK); 2016.

16. Wong JJ, Cote P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017 Feb;21(2):201-216. doi: 10.1002/ejp.931. Epub 2016 Oct 6.

17. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14.

18. Sitthipornvorakul E, Klinsophon T. The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials. Musculoskelet Sci Pract. 2018 Apr;34:38-46. doi: 10.1016/j.msksp.2017.12.003. Epub 2017 Dec 12.

19. Vanti C, Andreatta S. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disabil Rehabil. 2019 Mar;41(6):622-632. doi: 10.1080/09638288.2017.1410730. Epub 2017 Dec 5.

20. Karateev AE, Tsurgan AV. Aceclofenac: the experience of Russian studies. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2017;11(4):89-94. (In Russ.). doi: 10.14412/1996-7012-2017-4-89-94

21. Parfenov VA, Gerasimova ON. Treatment of nonspecific back pain in outpatient practice. Spravochnik poliklinicheskogo vracha. 2013;(1):48-51. (In Russ.).

22. Kukushkin ML, Gekht AB. The results of a randomized double-blind parallel study of efficacy and safety of the use tolperisone in patients with acute nonspecific pain in the lower back. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(1): 69-78. (In Russ.).

23. Rizzoli R, Stevenson JC, Bauer JM, et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of osteoporosis and osteoarthritis (ESCEO). Maturitas. 2014 Sep;79(1):122-32. doi: 10.1016/j.maturitas. 2014.07.005. Epub 2014 Jul 17.

24. Vuori IM. Dose-response of physical activity and low back pain, osteoarthritis, and osteoporosis. Med Sci Sports Exerc. 2001 Jun;33 (6 Suppl):S551-86; discussion 609-10.

25. Ahn N, Kim K. Effects of 12-week exercise training on osteocalcin, high-sensitivity C-reactive protein concentrations, and insulin resistance in elderly females with osteoporosis. J Phys Ther Sci. 2016 Aug;28(8):2227-31. doi: 10.1589/jpts. 28.2227. Epub 2016 Aug 31.

26. Otero M, Esain I, Gonzalez-Suarez AM, Gil SM. The effectiveness of a basic exercise intervention to improve strength and balance in women with osteoporosis. Clin Interv Aging. 2017 Mar 14;12:505-513. doi: 10.2147/CIA.S127233. eCollection 2017.

27. Sugiyama T, Oda H. Osteoporosis therapy: bone modeling during growth and aging. Front Endocrinol (Lausanne). 2017 Mar 9;8:46. doi: 10.3389/fendo.2017.00046. eCollection 2017.

28. Weaver CM, Alexander DD, Boushey CJ. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int. 2016 Jan;27(1):367-76. doi: 10.1007/s00198- 015-3386-5. Epub 2015 Oct 28

29. Watts NB, Lewiecki EM, Miller PD, Baim S. National osteoporosis foundation 2008 clinician's guide to prevention and treatment of osteoporosis and the world health organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J Clin Densitom. 2008 Oct-Dec; 11(4):473-7. doi: 10.1016/j.jocd.2008.04.003. Epub 2008 Jun 18.

30. Cano A, Chedraui P, Goulis DG. Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guide. Maturitas. 2018 Jan; 107:7-12. doi: 10.1016/j.maturitas.2017.10.004. Epub 2017 Oct 3.

31. Black DM, Rosen CJ. Clinical Practice. Postmenopausal Osteoporosis. N Engl J Med. 2016 Jan 21;374(3):254-62. doi: 10.1056/NEJMcp1513724

32. Qaseem A, Forciea MA. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update From the American College of Physicians. Ann Intern Med. 2017 Jun 6;166(11):818-839. doi: 10.7326/M15-1361. Epub 2017 May 9.


For citations:

Isaikin A.I., Isaikina O.Yu., Shadyzheva T.I., Shor Yu.M., Kachanovsky M.S. Back pain and osteoporosis. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3):63-68. (In Russ.)

Views: 1497

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)