Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: do bisphosphonates relieve pain caused by acute osteoporotic vertebral compression fractures?

摘要

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 osteo-penic 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.