Sudden onset of severe back pain following minimal or no trauma suggests an osteoporotic vertebral fracture. The presence of a dorsal kyphosis also points to osteoporosis. Treatment with narcotic analgesia is appropriate for a presumed vertebral fracture. Plain radiographs may or may not reveal the acute fracture but are useful to rule out other bone pathology, such as metastatic disease. This patient should have calcium supplementation, but other medication is indicated for treatment of osteoporosis. Estrogen, alendronate, and risedronate are FDA-approved for the prevention and treatment of osteoporosis but do not provide immediate relief.5 However, the FDA recommends nonestrogen treatments be considered first for osteoporosis. In addition to reducing vertebral fractures, calcitonin has been shown to produce significant alleviation of the acute pain from osteoporotic vertebral fractures.6
5. Siminoski K, Josse RG. Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 9. Calcitonin in the treatment of osteoporosis. CMAJ 1996;155:9625.
6. South-Paul JE. Osteoporosis: part II. Nonpharmacologic and pharmacologic treatment. Am Fam Physician 2001;63:11218.
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