Armingeat T et al. (2006) Intravenous pamidronate for pain relief in recent osteoporotic vertebral compression fracture: a randomized double-blind controlled study. Osteoporos Int 17: 1659–1665

A study in France has found that pamidronate (a bone antiresorptive agent) provides rapid and sustained pain relief in patients with osteoporotic vertebral compression fractures (VCFs), although the mechanism underlying this analgesic effect remains unclear. Few treatments for the acute back pain caused by VCFs have previously been studied, and strong analgesics are commonly administered, although they are poorly tolerated by some patients.

This 30-day, double-blind, randomized, placebo-controlled trial enrolled 32 patients with a recent osteoporotic vertebral compression, and acute pain of <21 days' duration. In total, 16 patients received intravenous pamidronate 30 mg on three consecutive days, and 16 patients received placebo. Both groups received concomitant treatment with paracetamol 1 g three times daily and were advised to rest. Patients who had been taking bisphosphonates, raloxifene or estrogen-replacement therapy for ≥3 months before enrollment continued such treatment.

On day 7, the mean decrease in standing pain (evaluated by a visual analog 0–100 mm scale) was 42 mm in the treatment group, compared with 23 mm in the placebo group. More patients achieved 20% and 50% reductions in standing pain on days 7 and 30 in the pamidronate-treated group, compared with the placebo-treated group. Only two patients experienced fever and transient muscle pain associated with pamidronate infusions.

The authors conclude that pamidronate provides effective and well-tolerated pain relief for osteoporotic VCFs, and might also help to prevent further vertebral fractures.