Bisphosphonates and musculoskeletal pain not linked after all?

Contrary to earlier reports, oral bisphosphonate use in older patients at high risk for osteoporosis does not appear to be associated with a significant risk of subsequent musculoskeletal pain. In addition, incident musculoskeletal pain may not result in a significant increase in the rate of bisphosphonate discontinuation.

Caplan and associates retrospectively analyzed data from 26,565 persons 65 years and older with a previous fracture who had been taking bisphosphonates for a year or longer. They surmised that the risk of pain was greater in persons taking these medications than in those who were bisphosphonate-naive and tested their theory that the risk of pain varies with preparation and dosing regimen. They controlled for factors that can contribute to musculoskeletal pain, something that other studies reporting bisphosphonate-related pain had not done.

Musculoskeletal pain was greatest in persons at risk for pain, regardless of treatment. This included women, as well as those who were anxious or depressed or had other disease, including rheumatologic disease. With controlling for all confounders, musculoskeletal pain was not greater in the bisphosphonate group and it did not prompt discontinuation of this treatment.

The authors suggested that similar studies be done in other populations before widespread conclusions are drawn.