Pain and other physical problems in osteoporosis

Osteoporosis is often referred to as a 'silent condition' and often a fracture is the first symptom that leads to investigation and diagnosis of the condition. Pain is not a symptom of osteoporosis in the absence of fractures. 
Following a fracture, bones tend to heal within six to eight weeks but pain and other physical problems, such as pain and tiredness or fatigue, may continue. Here, the people we interviewed talk about what it is like to live with pain, what triggers it and what they do to help ease the pain. The different ways people cope in their everyday life with pain and other physical problems is discussed in other summaries (see section on Living with osteoporosis).
Most people we talked to described having pain in their bones and muscles, particularly in their back but also hips, arms, ribs and knees were mentioned. The level of pain differed and while many people dealt with some level of pain on a regular basis it was particularly challenging for those who suffered severe pain due to collapsed vertebrae or bone deterioration. Also it may take longer for people to recover from the emotional effect of pain and normalise their everyday activities again. Younger adults compared themselves with others in their peer group and because they could no longer be as active, their self-esteem was affected (see also Feelings and thoughts about osteoporosis).
According to the people we talked to an array of things and activities can trigger pain besides fractures, such as carrying weight, tiredness, cold or damp weather, heavy manual work, wrong diet, lifting and bending and ‘overdoing’ it. Many people indicated that standing up and/or sitting in the same position for a short time will trigger pain.
The experience of pain is personal and people said that they have noticed that it increases or appears at various times during the day or night. For some it can be first thing in the morning or mid-day after they have been active for a bit and, for others it is always worse at night.
Whilst many of the people we talked to have learnt to manage their pain themselves, Robert was referred to a pain management clinic and several said that they got advice from a physiotherapist, a support group or phoned the National Osteoporosis Society Helpline (NOS). But most people used what James termed ‘a common sense’ approach to controlling pain and reducing its impact on their lives. Most people said that they include in their daily routine regular rest ‘breaks’ in the form of naps, lying down, sitting and relaxing. Although lying down can help with pain relief, spending too much time in this position is not good as it weakens the strength and tone of the muscles in the back.
Walking and stretching exercises were also mentioned, as well as diet. Heat seemed to help with the pain. Beryl used an electric blanket at night. Several people have invested in a memory foam mattress and cushions to help them cope with pain and sleeplessness at night. Joan found that both a session in the Jacuzzi and distractions were beneficial. Valerie explained that she avoids straining her back and she reads lying down and only reads paperbacks because the weight of a hardback will trigger back pain (see Osteoporosis and exercise).

Several people felt that their pain and/or other physical problems had improved and attributed this to diet, exercise and medication for osteoporosis. 

However, most of the people we talked to take some form of pain relief medication to manage pain which in turn, helps them sleep at night. Pain medication ranges from the occasional paracetamol to morphine patches (see also Pain and medication with osteoporosis).
Leisure activities or work were mentioned by several people as ‘taking their mind of pain’. Some find that they feel more pain when they are inactive. When they are busy and concentrating on other things they either do not notice or do not feel pain. Doing the things that gives them pleasure, like being in the company of friends or simply watching a good TV programme, can make a difference to how they feel.
Some elderly people we talked to said that they have more than one condition to worry about such as arthritis, osteoarthritis and polymialgia. In fact, several indicated that they lived with the damage caused by osteoporosis but that their pain and disability has been exacerbated by their other conditions. Betty, for instance said that she had a spell of arthritis twenty-five years ago and more recently was diagnosed with osteoarthritis of the spine, the hips and the pelvis, apart from her osteoporosis. So she finds it difficult to know which condition is increasing her pain and disability.
Several people said that they have ‘slight’ osteoporosis or osteopenia and do not tend to experience pain but occasionally, they may have an ‘ache’. But while osteoporosis hasn’t affected their lives too much, they are aware, like everyone else, of the risk of fracture and the need to avoid doing certain things, like running or lifting heavy objects, as well as self-help to maintain their well being.
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To rate, describe or classify pain is not an easy task. Jane found it difficult, when asked by a doctor, to pick a number from one to ten to rate her level of pain. She felt uncomfortable to admit to a high level of pain and suggested a number in the middle band because she thought it could be more acceptable.
But some people used various ways to describe pain such as ‘useful’, ‘sharp’, ‘dull’, ‘hot’, ‘referred pain’ and ‘useless.’ Jane understands the difference between good pain and bad pain but said that in practice it is not so easy to differentiate whether pain is the result of exercise or the exercise has caused any further damage.
Other physical problems
Tiredness/fatigue, sleeping problems and breathlessness were other physical problems affecting the people we talked with.
People commented that pain and tiredness often went together because pain made it hard to sleep, or even rest. Many indicated that they needed to have one or two naps during the day but this was not possible for those who were still working. Many like Robert, Emma and Jane commented that their sleeping pattern had been affected and that they hadn’t been able to have a whole night's sleep for years. Lack of, or disrupted sleep can also aggravate stiffness and feeling fatigued can make people feel less stable. Robert described a vicious circle that made him feel constantly under physical and emotional pressure.
To some extent, the prevailing attitude is to try and continue to live as normally as the pain and other physical problems will allow. People use expressions such as ‘to get on with things’ or ‘not to give in to pain’, and others like David have learned to accept and live with their pain and noted that over the years they seemed to have developed a high pain threshold. But pain, tiredness and lack of sleep can also make people feel angry, worry, annoyed, upset and frightened (see also Feelings and thoughts about osteoporosis).
Feeling tired can be caused by other reasons apart from pain. Beryl and Joan have breathing difficulties and have to rely on oxygen every day. Both said that their level of activity is restricted. Joan has severe kyphosis and Beryl has emphysema. Breathing difficulties are a secondary problem. Where multiple vertebral fractures are present, particularly in thoracic spine a kyphosis can develop. In turn, this causes a protrusion of the abdomen because the space between the ribs and the pelvis is becoming less. This can result in respiratory and gastrointestinal problems Some other people also noticed that particular medications made them feel tired (see also Pain and medication with osteoporosis).
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Physical problems seldom stayed the same. Some people found that the pain, tiredness, stiffness and so forth that result from osteoporosis (and other conditions) seemed less severe, changed in other ways, or became worse over time.

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Last reviewed June 2017.
Last updated June 2017.


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