臨床整形外科52巻9号

2017年09月発行

連載 慢性疼痛の治療戦略　治療法確立を目指して・13

—ガイドラインを考慮した治療—骨粗鬆に伴う疼痛

著者： 折田純久¹ 稲毛一秀¹ 鈴木都¹ 大鳥精司¹

所属機関： ¹千葉大学大学院医学研究院整形外科学

ページ範囲：P.900 - P.904

骨粗鬆症と痛み

　骨粗鬆症患者における痛みには，骨折などの外傷に伴うものと骨粗鬆自体そのものがもたらす痛み(骨粗鬆性疼痛)があり(図1)，破骨細胞の活性化や疼痛感受性の亢進が一因と考えられている．また，臨床における高齢者の急性腰痛の8割近くにMRI上の骨髄輝度変化がみられ，骨傷の潜在的な存在の可能性が示唆されるなど¹⁾，骨粗鬆症に関連する痛みには不明な点も多い．骨折などの外傷性の疼痛に対しては一般的な消炎鎮痛薬が用いられるが，骨粗鬆性疼痛についてはすべての機序はいまだ研究途上にあるためその薬物治療効果は完全に明らかにはなっていないが，骨粗鬆症薬による骨吸収抑制・骨形成促進を中心とした骨環境の整備が鎮痛効果につながるものと認識されている．

　本稿では運動器慢性疼痛の一因となりうる骨粗鬆性疼痛の機序について最新の知見を概観し，薬物療法の効果と可能性について述べる．

参考文献

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