Back pain and spinal osteoporosis in clinical practice
https://doi.org/10.21518/2079-701X-2019-18-119-126
Abstract
Back pain is a common clinical and socioeconomic problem. Back pain is a symptom, not a nosological form. Osteoporosis is a skeletal disease in which, despite normal bone mineralization, bone loss and bone (structure) integrity is observed. The article considers the main causes of primary and secondary osteoporosis. The main modifiable and unmodifiable risk factors for osteoporosis and fractures are presented. The main pathological conditions and diseases associated with the risk of osteoporosis are described. The problem of osteoporosis of the spine as one of the causes of mechanical painful episodes in the back of elderly patients is considered in depth. Clinical features of compression vertebral fractures in osteoporosis in women after menopause are presented. The methods of conservative treatment of osteoporosis are considered. The greatest attention is paid to such effective antiosteoporotic drugs as bisphosphonates. The data on the efficacy and tolerability of alendronic acid preparations as the most studied preparation from the group of bisphosphonates are analyzed. The information on the new medicinal form of alendronic acid – sparkling soluble tablets (Binosto) is presented.
About the Authors
N. V. Pizova
Federal State Budgetary Educational Institution of Higher Education «Yaroslavl State Medical University» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Nataliya V. Pizova, Dr. of Sci. (Med), Professor, Department of Nervous Diseases with Medical Genetics and Neurosurgery
5, Revolutsionnaya St., Yaroslavl, 150000
A. V. Pizov
Federal State Budgetary Educational Institution of Higher Education «Yaroslavl State Medical University» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Aleksandr V. Pizov, Cand. of Sci. (Bio), Associate Professor
108/1, Respublikanskaya St., Yaroslavl, 150000
References
1. Nachemson A. Epidemiology and the economics of low back pain. In: Herkowits H., Dvorak J., Bell G., Nordin M., Grob D., (eds.). The Lumbar Spine. 3rd edition. Philadelphia, Pa, USA: Lippincott; 2004.
2. Shiri R., Solovieva S., Husgafvel-Pursiainen K., Taimela S., Saarikoski L.A., Huupponen R., Viikari J., Raitakari O.T., Viikari-Juntura E. The association between obesity and the prevalence of low back pain in young adults: the cardiovascular risk in young finns study. American Journal of Epidemiology. 2008;167(9):1110–1119. doi: 10.1093/aje/kwn007.
3. Strine T.W., Hootman J.M. US national prevalence and correlates of low back and neck pain among adults. Arthritis Care and Research. 2007;57(4):656–65. doi: 10.1002/art.22684.
4. Dubinina T.V., Galushko E.A., Erdes S.F. Frequency and character of low back pain among outpatients in Moscow. Report II. Rheumatology Science and Practice. 2008;46(2):6-12. (In Russ.) Available at: doi: 10.14412/1995-4484-2008-425.
5. Leveille S.G., Guralnik J.M., Hochberg M., Hirsch R., Ferrucci L., Langlois J., Rantanen T., Ling S. Low back pain and disability in older women: independent association with difficulty but not inability to perform daily activities. Journals of Gerontology Series A. 1999;54(10):487–493. doi: 10.1093/gerona/54.10.m487.
6. Hartvigsen J., Christensen K., Frederiksen H. Back and neck pain exhibit many common features in old age: a population-based study of 4,486 danish twins 70–102 years of age. Spine. 2004;29(5):576–580. doi: 10.1097/01. brs.0000099394.18994.2f.
7. Leboeuf-Yde C., Nielsen J., Kyvik K.O., Fejer R., Hartvigsen J. Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age. BMC Musculoskeletal Disorders. 2009;(10):39. doi: 10.1186/14712474-10-39.
8. Sambrook P., Cooper C. Osteoporosis. Lancet. 2006;(367):2010–2018. doi: 10.1016/S01406736(06)68891-0.
9. Pfeifer M., Gehlen M., Hinz C. Spinal orthoses in the treatment of vertebral fractures with osteoporosis: A systematic review article. Z Rheumatol. 2017;76(10):860-868. doi: 10.1007/ s00393-017-0404-3.
10. Ralston S.H., Fraser J. Diagnosis and management of osteoporosis. Practitioner. 2015;259(1788):15-9. Available at: www.ncbi. nlm.nih.gov/pubmed/26882774.
11. Osteoporosis prevention, diagnosis, and therapy. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. JAMA. 2001;285(6):785-795. doi: 10.1001/jama.285.6.785.
12. Nasonov E.L., Skripnikova I.A., Nasonova V.A. The problem of osteoporosis in rheumatology. Moscow: Stin; 1997. (In Russ.)
13. Treatment of postmenopausal osteoporosis. N Engl J Med. 1998;338(11):736-746. doi: 10.1056/NEJM199803123381107.
14. Benevolenskaya L.I. General principles of prevention and treatment of osteoporosis. Consilium medicum. 2000;(2):240-244. (In Russ.) Available at: http://old.consilium-medicum.com/media/consilium/00_06/240.shtml.
15. Benevolenskaya L.I. Osteoporosis manual = Rukovodstvo po osteoporozu. Moscow: Binom; 2003. (In Russ.)
16. Lesnyak O.M., Benevolenskaya L.I. (ed.). Osteoporosis. Moscow: GEOTAR-Media; 2010. (In Russ.)
17. Muradyants A.A., Shostak N.A Osteoporosis in General therapeutic practice: from diagnostic hypothesis to differential diagnosis. The Clinician. 2012;6(2):67-75. (In Russ.) doi: 10.17650/1818-8338-2012-6-2-67-75.
18. Grossman D.C., Curry S.J., Owens D.K., Barry M.J., Caughey A.B., Davidson K.W., et al. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(15):1592-1599. doi: 10.1001/jama.2018.3185.
19. Sözen T., Özışık L., Başaran N.Ç. An overview and management of osteoporosis. Eur J Rheumatol. 2017;4(1):46-56. doi: 10.5152/eurjrheum.2016.048.
20. Alexandru D., So W. Evaluation and management of vertebral compression fractures. Perm J. 2012;16(4):46-51. doi: 10.7812/tpp/12-037.
21. Lindsay R., Silverman S.L., Cooper C., Hanley D.A., Barton I., Broy S.B., et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285(3):320-323. doi: 10.1001/ jama.285.3.320.
22. Roux C., Fechtenbaum J., Kolta S., Briot K., Girard M. Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int. 2007;18(12):1617-1624. doi: 10.1007/s00198-007-0413-1.
23. Hendrickson N.R., Pickhardt P.J., Del Rio A.M., Rosas H.G., Anderson P.A. Bone Mineral Density T-Scores Derived from CT Attenuation Numbers (Hounsfield Units): Clinical Utility and Correlation with Dual-energy X-ray Absorptiometry. Iowa Orthop J. 2018;(38):25-31. Available at: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6047377/.
24. Bianchi M.L., Orsini M.R., Saraifoger S., Ortolani S., Radaelli G., Betti S. Quality of life in post-menopausal osteoporosis. Health Qual Life Outcomes. 2005;(3):78. doi: 10.1186/14777525-3-78.
25. Shostak N.A., Pravdyuk N.G., Shvireva N.V., Egorova V.A. Back pain in the elderly – approaches to the diagnosis and treatment. The Clinician. 2011;5(3):73-77. (In Russ.) doi: 10.17650/1818-8338-2011-3-73-77.
26. Shostak N.A., Pravdyuk N.G. Back pain associated with osteoporosis — management algorithm, approach to therapy. The Clinician. 2012;6(1):86-90. (In Russ.) doi: 10.17650/1818-8338-2012-1-86-90.
27. Painter S.E., Kleerekoper M., Camacho P.M. Secondary osteoporosis: a review of the recent evidence. Endocr Pract. 2006;12(4):436−45. doi: 10.4158/EP.12.4.436.
28. McCullough B.J., Comstock B.A., Deyo R.A., Kreuter W., Jarvik J.G. Major medical outcomes with spinal augmentation vs conservative therapy. JAMA Intern Med. 2013;173(16):151421. doi: 10.1001/jamainternmed.2013.8725.
29. Zhan Y., Jiang J., Liao H., Tan H., Yang K. Risk Factors for Cement Leakage After Vertebroplasty or Kyphoplasty: A MetaAnalysis of Published Evidence. World Neurosurg. 2017;(101):633-642. doi: 10.1016/j. wneu.2017.01.124.
30. Dedov I.I., Mel’nichenko G.A., Belaia Zh.E., Rozhinskaia L.Ia. Osteoporosis: from a rare symptom of endocrine diseases to the tacit epidemic of XX-XXI centuries. Problems of endocrinology. 2011;57(1):35-45. (In Russ.) Available at: https://www.mediasphera.ru/ issues/problemy-endokrinolog ii/2011/1/030375-9660201116.
31. MacLean C., Newberry S., Maglione M., McMahon M., Ranganath V., Suttorp M., et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008;148(3):197-213. doi: 10.7326/0003-4819-148-3-200802050-00198.
32. Feldstein A.C., Nichols G., Orwoll E., Elmer P.J., Smith D.H., Herson M., Aickin M. The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int. 2005;16(8):953-62. doi: 10.1007/s00198-0051950-0.
33. Boonen S., Reginster J.Y., Kaufman J.M., Lippuner K., Zanchetta J., Langdahl B., et al. Fracture risk and zoledronic acid therapy in men with osteoporosis. N Engl J Med. 2012;367(18):1714-23. doi: 10.1056/ NEJMoa1204061.
34. Mellström D.D., Sörensen O.H., Goemaere S., Roux C., Johnson T.D., Chines A.A. Seven Years of Treatment with Risedronate in Women with Postmenopausal Osteoporosis. Calcif Tissue Int. 2004;75(6):462-468. doi: 10.1007/s00223004-0286-7.
35. Thompson K. Cytosolic Entry of Bisphosphonate Drugs Requires Acidification of Vesicles after Fluid-Phase Endocytosis. Molecular Pharmacology. 2006;69(5):16241632. doi: 10.1124/mol.105.020776.
36. Dunford J., Rogers M., Ebetino F., Phipps R., Coxon F. Inhibition of Protein Prenylation by Bisphosphonates Causes Sustained Activation of Rac, Cdc42, and Rho GTPases. J Bone Miner Res. 2006;21(5):684-694. doi: 10.1359/jbmr.060118.
37. Belaya Zh.E., Rozhinskaya L.Ya. Bisphosphonates in the therapy of postmenopausal osteoporosis. Doktor.Ru. 2010;(7):29-38. (In Russ.) Available at: https://elibrary.ru/item. asp?id=17111534.
38. Liberman U.A., Weiss S.R., Bröll J., Minne H.W., Quan H., Bell N.H., et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med. 1995;333(22):14371443. doi: 10.1056/NEJM199511303332201.
39. Black D.M., Cummings S.R., Karpf D.B., Cauley J.A., Thompson D.E., Nevitt M.C., et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996;348(9041):1535-41. doi: 10.1016/s0140-6736(96)07088-2.
40. Cummings S.R., Black D.M., Thompson D.E., Applegate W.B., Barrett-Connor E., Musliner T.A., et al. Effect of alendronate on risk of fracture in women with low bone mineral density but without vertebral fractures. JAMA. 1998;280(24):2077-82. doi: 10.1001/ jama.280.24.2077.
41. Ensrud K.E., Black D.M., Palermo L., Bauer D.C., Barrett-Connor E., Quandt S.A., Thompson D.E., Karpf D.B. Treatment with alendronate prevents fractures in women at highest risk. Arch Intern Med. 1997;157(22):2617-24. doi: 10.1001/archinte.1997.00440430099012.
42. Bone H.G., Hosking D., Devogelaer J.P., Tucci J.R., Emkey R.D., Tonino R.P., et al. Alendronate phase III osteoporosis treatment study group. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004;350(12):1189-1199. doi: 10.1056/NEJMoa030897 .
43. Shiraki M., Kushida K., Fukunaga M., Kishimoto H., Taga M., Nakamura T., et al. Alendronate Phase III Osteoporosis Treatment Research Group A double-masked multicenter comparative study between alendronate and alfacalcidol in Japanese patients with osteoporosis. Osteoporos Int. 1999;(10):183–192. doi: 10.1007/s001980050214.
44. Kushida K., Shiraki M., Nakamura T., Kishimoto H., Morii H., Yamamoto K., et al. Alendronate reduced vertebral fracture risk in postmenopausal Japanese women with osteoporosis: a 3-year follow-up study. J Bone Miner Metab. 2004;(22):462–468. doi: 10.1007/s00774-0040508-0.
45. Olszynski W.P., Davison K.S., Ioannidis G., Brown J.P., Hanley D.A., Josse R.G., et al. Effectiveness of alendronate and etidronate in the treatment of osteoporosis in men: a prospective observational study. Osteoporos Int. 2006;17(2):217–24. doi: 10.1007/s00198005-1965-6.
46. Hagsten B., Svensson O., Gardulf A. Healthrelated quality of life and selfreported ability concerning ADL and IADL after hip fracture: a randomized trial. Acta Orthop. 2006;(77):114– 119. doi: 10.1080/17453670610045786.
47. National Institute for Health and Clinical Excellence (2011) Osteoporosis—Secondary Prevention including Strontium Ranelate. Alendronate, Etidronate, Risedronate, Raloxifene, Strontium Ranelate and Teriparatide for the Secondary Prevention of Osteoporotic Fragility Fractures in Postmenopausal Women. Technical Appraisal 161. Available at: http://www.nice.org.uk/TA16.
48. Kanis J.A., Cooper C., Hiligsmann M., Rabenda V., Reginster J.Y., Rizzoli R. Partial adherence: a new perspective on health economic assessment in osteoporosis. Osteoporos Int. 2011;22(10):256573. doi: 10.1007/s00198-011-1668-0.
49. Siris E.S., Harris S.T., Rosen C.J., Barr C.E., Arvesen J.N., Abbott T.A., Silverman S. Adherence to bisphosphonate therapy: relationship to bone fractures at 24 months in women with postmenopausal osteoporosis. Mayo Clin Proc. 2006;81(8):1013–1022. doi: 10.4065/81.8.1013.
50. Hansen C., Pedersen B.D., Konradsen H., Abrahamsen B. Antiosteoporotic therapy in Denmark predictors and demographics of poor refill compliance and poor persistence. Osteoporos Int. 2013;24(7):2079-97. doi: 10.1007/s00198-012-2221-5.
51. Lesnyak O.M., Evstigneeva L.P., Koval A.M. et al. Commitment of Russian patients to osteoporosis treatment (national project «Strength in Constancy»). Pharmateca = Farmateka. 2008;(3):73–79. (In Russ.) Available at: https:// pharmateca.ru/ru/archive/article/7095.
52. Cooper A., Drake J., Brankin E. PERSIST Investigators. Treatment persistence with oncemonthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study. Int J Clin Pract. 2006;60(8):896905. doi: 10.1111/j.1742-1241.2006.01059.x.
53. Siris E.S., Selby P.L., Saag K.G., Borgstrom F., Herings R.M., Silverman S.L. Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med. 2009;122(2 Suppl):3-13. doi: 10.1016/j. amjmed.2008.12.002.
54. Abraham S.C., Cruz-Correa M., Lee L., Yardley J.H., Wu T.T. Alendronate-associated esophageal injury: pathologic and endoscopic features. Mod Pathol. 1999;12(12):1152-1157. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10619269.
55. Lufkin E.G., Argueta R., Whitaker M.D., Cameron A.L., Wong V., Egan K.S., O’Fallon W.M., Riggs B.L. Pamidronate: an unrecognized problem in gastrointestinal tolerability. Osteoporosis Int. 1994;4(6):320–322. doi: 10.1007/bf01622190.
56. De Groen P.C., Lubbe D.F., Hirsch L.J., Daifotis A., Stephenson W., Freedholm D., PryorTillotson S., Seleznick M.J., Pinkas H., Wang K.K. Esophagitis associated with the use of alendronate. N Engl J Med. 1996;335(14):10161021. doi: 10.1056/NEJM199610033351403.
57. Gertz B.J., Holland S.D., Kline W.F., Matuszewski B.K., Porras A.G. Clinical pharmacology of alendronate sodium. Osteopor Int. 1993;3(suppl. 3):513–516. doi: 10.1007/ bf01623002.
58. Argenzio R.A., Eisemann J. Mechanisms of acid injury in porcine gastroesophageal mucosa. Am J Vet Res. 1996;57(4):564-573. Available at: https:// www.ncbi.nlm.nih.gov/pubmed/8712526.
59. Piscitelli P., Auriemma R., Neglia C., Migliore A. Alendronate: new formulations of an old and effective drug to improve adherence avoiding upper gastrointestinal side effects. Eur Rev Med Pharmacol Sci. 2014;18(24):3788–3796. Available at: http://www.ncbi.nlm.nih.gov/ pubmed/25555868.
60. Gómez Acotto C., Antonelli C., Flynn D., McDaid D., Roldán E.J. Upper gastrointestinal tract transit times of tablet and drinkable solution formulations of alendronate: a bioequivalence and a quantitative, randomized study using video deglutition. Calcif Tissue Int. 2012;91(5):325-334. doi: 10.1007/s00223012-9639-9.
Review
For citations:
Pizova NV, Pizov AV. Back pain and spinal osteoporosis in clinical practice. Meditsinskiy sovet = Medical Council. 2019;(18):119-126. (In Russ.) https://doi.org/10.21518/2079-701X-2019-18-119-126
Views:
676
Email this article 