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Do bisphosphonates relieve pain caused by acute osteoporotic vertebral compression fractures?

Report by: Emma Jenkinson, Foundation Year 1

Search checked by: Jamie Coleman, Suresh Babu, Robin Ferner, SpR in Clinical Pharmacology, Consultant Clinical Pharmacologist, Consultant Interventional Radiologist

Institution: City Hospital, Birmingham, UK

Clinical scenario

A 72-year-old woman presents to the emergency department with severe back pain after a mechanical fall. Plain radiographs of her thoracic spine show osteopenic vertebrae with a wedge compression fracture of the body of T8. Her pain is controlled acutely with paracetamol, ibuprofen and oral morphine sulphate. She is mobilised and arrangements are made for her to have physiotherapy in the community. You are keen to discharge this patient but want to maintain pain control and, given the potential side effects, would prefer to avoid opiates and non-steroidals. You have heard that some bisphosphonates relieve the pain of pathological fractures and wonder whether they do so in vertebral compression fractures.

Three-part question

In [patients with osteoporotic vertebral compression fractures] do [bisphosphonates] reduce [pain]?

Search strategy

MEDLINE 1950–November Week 2, 2010; EMBASE 1980–2010, Week 46 and the Cochrane Library November 2010.

MEDLINE and EMBASE: exp fractures, compression/OR exp spinal …

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