title: Bone pain mechanism in osteoporosis: a narrative review.
abstract: Bone pain in elderly people dramatically affects their quality of life, with osteoporosis being the leading cause of skeletal related events. Peripheral and central mechanisms are involved in the pathogenesis of the nervous system sensitization. Osteoporosis in the elderly has been associated with increased density of bone sensory nerve fibers and their pathological modifications, together with an over-expression of nociceptors sensitized by the lowering pH due to the osteoclastic activity. The activation of N-methyl-D-aspartate (NMDA) receptors and the microglia, as a response to a range of pathological conditions, represent the leading cause of central sensitization. Unfortunately, osteoporosis is named the "silent thief" because it manifests with painful manifestation only when a fracture occurs. In the management of patients suffering from bone pain, both the nociceptive and the neuropathic component of chronic pain should be considered in the selection of the analgesic treatment.
authors.affiliation: Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesiology, Intensive care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine, "Polo Pontino", "Sapienza" University of Rome, Italy.
authors.forename: Consalvo
authors.initials: C
authors.lastname: Mattia
authors.affiliation: Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesiology, Intensive care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine, "Polo Pontino", "Sapienza" University of Rome, Italy.
authors.forename: Flaminia
authors.initials: F
authors.lastname: Coluzzi
authors.affiliation: Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesiology, Intensive care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine, "Polo Pontino", "Sapienza" University of Rome, Italy.
authors.forename: Ludovica
authors.initials: L
authors.lastname: Celidonio
authors.affiliation: Palliative Care and Pain Therapy Unit, University Hospital of Careggi, Florence, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Vellucci
keywords: bone; opioids; osteoporosis; pain mechanism