By Sarah Bence, OTR/L 

 Medically reviewed by David Ozeri, MD

Osteoporosis is not painful by itself, but it can lead to bone fractures that can result in long-term, chronic pain. Approximately 50% of women and 25% of men will break a bone due to osteoporosis at some point in their lives, so it is important to be aware of the associated pain.1

In this article, learn more about osteoporosis, its sources of pain, and how to cope.

Jasmin Merdan / Getty Images

Sources of Osteoporosis Pain

Pain from osteoporosis varies in intensity and depends on its exact cause. Typically, fractures account for osteoporosis-related pain, but certain medications can also cause pain.

About 2 million broken bones per year are due to osteoporosis in the United States.1

Stress Fractures

A stress fracture is a tiny break in a bone, usually due to repetitive movement. Over time, if a muscle group is overused or a force is repeatedly applied, it may transfer some of this force to the nearby bones, which in time, may become unable to absorb the pressure and crack.

People with osteoporosis develop stress fractures more easily because their bones are more brittle and unable to absorb this extra force.

Compression Fractures

A compression fracture occurs when the vertebrae (bones in the spine that stack on top of each other and protect the spinal cord) become weakened and collapse into each other. Osteoporosis is the most common cause of spinal compression fractures.2

Compression fractures cause back pain that can either come on slowly or be sudden and severe. Some compression fractures also press on the nerves, which can cause nerve pain. Additionally, some people with compression fractures develop a hunchback (called dorsal kyphosis), which can also cause pain and limit movement.

Trabecular Microfractures

Trabecular bone is the porous, spongy bone tissue inside a bone that surrounds the marrow. Microfractures of this tissue are common among people with osteoporosis.3

Medication Side Effects

Ironically, some medications that treat osteoporosis may cause bone pain as a side effect.

Medications that treat osteoporosis, whose side effects may include bone, muscle, and joint pain, include:45

• Bisphosphonates (medications that reduce bone loss)

• Xgeva and Prolia (denosumab) (biological medicines derived from living organisms)

How to Manage Osteoporosis Pain

There are several ways to manage osteoporosis-related pain, including medication, physical therapy, exercise, and more.

Medication

Sometimes, analgesic (pain-relieving) medications treat osteoporosis-associated pain. This could result from sudden pain from a broken bone or chronic pain. Different medications may be recommended based on pain level, cause, and duration.

Medications that treat osteoporosis pain may include:6

• Mild pain: Non-steroidal anti-inflammatory drugs (NSAIDs) or Tylenol (acetaminophen)

• Moderate pain: Weak opioids with or without NSAIDs or acetaminophen; adjuvant therapy

• Strong pain: Opioids with NSAIDs or acetaminophen; adjuvant therapy

Heat and Ice

Applying heat or cold therapies may help relieve some pain from osteoporosis. Examples include heating pads, ice packs, hot or cold plunge pools, and ultrasound. Alternating hot and cold may also help.

Consulting a healthcare provider before using heating or cooling therapies is recommended. Some methods may be contraindicated; for example, it is better to use cold therapy immediately after breaking a bone to reduce inflammation and swelling.

Thermal therapies may not be recommended for people with nerve involvement. Using very cold or very hot packs may also cause burning or other side effects.

Bracing

A brace is a wearable device that supports your bones and muscles and limits movement to varying degrees. Sometimes, your healthcare provider may recommend a brace to heal and support osteoporosis-associated fractures. Back braces are commonly recommended for people with compression fractures.7

Physical Therapy

Your healthcare provider may recommend physical therapy if you have pain from osteoporosis-related fractures. A physical therapist can prescribe a personalized evidence-based exercise regimen that includes weight-bearing and resistance exercises designed to manage your pain, prevent further postural deformity, and prevent bone density loss.

Occupational Therapy

You may also be referred to an occupational therapist who specializes in enabling people to perform activities that are meaningful to them.

If you have osteoporosis, they may help you modify your home environment, recommend adaptive equipment, or recommend ways of performing your activities of daily living—such as showering, dressing, or eating—in a way that reduces pain. They may also offer advice about how to reduce your risk of falls, which are extremely dangerous for people with osteoporosis.

Exercise

Exercise, particularly weight-bearing and resistance exercises, can help slow bone loss. Some activities with evidence to support them for osteoporosis include:6

• Yoga

• Pilates

• Wuqinxi (a Chinese mind-body exercise)

However, exercise can also be painful for people with osteoporosis and may even lead to the stress fractures they try to avoid. That's why consulting with a physical therapist or another orthopedic health professional before starting a new exercise program with osteoporosis is recommended.

Complementary Therapy

Some complementary approaches may also help you manage osteoporosis-related chronic pain.

Acupuncture, a Chinese medicine that involves sticking thin needles into strategic "energy channels" along the body, can improve pain and bone mineral density among people with osteoporosis.8

Other recommended therapies include the following:9

• Massage

• Biofeedback (a form of therapy that can help you gain control over involuntary body processes that block pain)

• Relaxation techniques

• Behavior modifications

• Transcutaneous electric nerve stimulation (TENS) units (applying an electrical current that can block pain)

When to Seek Care

Osteoporosis is considered a "silent disease" until it's not. There are usually no signs of osteoporosis until you get an often very painful bone fracture. Screening for osteoporosis is important and can help prevent fractures and osteoporosis pain.

Consider speaking to a healthcare provider if you have new pain (whether it comes on suddenly or gradually) or posture changes. They can perform a bone density scan if you are not already diagnosed with osteoporosis.

Summary

It is essential to diagnose and treat osteoporosis to prevent painful fractures. Some treatments, such as medication, physical or occupational therapy, heat or ice therapy, bracing, and exercise, can help manage chronic pain due to osteoporosis.

 Sources

National Osteoporosis Foundation. Osteoporosis fast facts.

Cedars Sinai. Compression fracture.

Okazaki N, Chiba K, Taguchi K. Trabecular microfractures in the femoral head with osteoporosis: analysis of microcallus formations by synchrotron radiation micro CT. Bone. 2014;64:82-87. doi:10.1016/j.bone.2014.03.039

National Health Service. Osteoporosis.

Bone Health & Osteoporosis Foundation. Side effects of bisphosphonates (alendronate, ibandronate, risedronate and zoledronic acid).

Paolucci T, Saraceni V, Piccinini G. Management of chronic pain in osteoporosis: challenges and solutions. J Pain Res. 2016;9:177-186. doi:10.2147/JPR.S83574

NYU Langone. Nonsurgical treatment for spinal compression fractures.

Xu G, Xiao Q, Zhou J, et al. Acupuncture and moxibustion for primary osteoporosis: an overview of systematic review. Medicine. 2020;99(9):e19334. doi:10.1097/MD.0000000000019334

Bone Health & Osteoporosis Foundation. Overall health.

Ahmadieh H, Arabi A. Vitamins and bone health: beyond calcium and vitamin D. Nutr Rev. 2011;69(10):584-598. doi:10.1111/j.1753-4887.2011.00372.x

By Sarah Bence, OTR/L
Bence is an occupational therapist with a range of work experience in mental healthcare settings. She is living with celiac disease and endometriosis.