- Drug Choice for Back Pain in Osteoporosis
The drug Forteo (teriparatide) is better than Fosamax (alendronate) for treating back pain related to osteoporosis. In a randomized controlled study of 146 women reported in the Journal of Rheumatology, half received an oral placebo and a self-injection of 40 micrograms of Forteo daily. The other half received 10 milligrams of Fosamax daily and a self-injection of a placebo. The active phase of the study lasted for a median of 14 months and the follow-up phase of the study lasted for an additional 2.5 years.
Significantly fewer women in the Forteo group reported back pain vs. those in the Fosamax group. This difference held throughout the follow-up period. Both Forteo and Fosamax reduce the risk of new vertebral fractures. But the specific reasons that Forteo might be better for treating back pain are unknown. The two drugs have essentially opposite effects on bone turnover, with Fosamax suppressing bone remodeling and preventing bone loss and Forteo increasing bone remodeling and stimulating bone formation.
The Forteo dose used in this study is higher than that approved by the FDA. However, previous studies have found that the approved dose—20 mcg— reduces back pain compared to a placebo.
And speaking of back pain, if you suffer from low back pain you’ll be interested in reading these new findings, reported in the Annals of Internal Medicine …
- Exercise Therapy for Low Back Pain
Two studies of low back pain from the same research team confirm that exercise is effective for chronic low back pain—but it may not be the best choice for acute low back pain.
In the first study, a meta-analysis of 61 randomized, controlled trials, researchers evaluated 11 studies of acute back pain, six of subacute pain and 43 of chronic pain (one trial was unclear). Overall, they found that exercise is at least as effective as other conservative treatments for chronic low back pain. For subacute pain, there is some evidence to support a program of gradually increasing exercise. For acute pain, however, they found that exercise isn’t necessarily more effective than other conservative treatments. They emphasize that exercise therapy is not the same as the advice to stay active (and to get up out of bed), which is the basic recommended treatment strategy for acute back pain.
In the second study, the research team looked more closely at the 43 studies of chronic low back pain. The studies evaluated a total of 72 exercise treatments; overall, stretching and strengthening exercises worked best to reduce pain and increase function, the researchers said. Other strategies that proved effective included over-the-counter pain relievers and manual therapy (manipulation of the back).
