Multidisciplinary rehabilitation for chronic pain in osteoporosis: advantages of a comprehensive pathogenetic approach compared to isolated pharmacotherapy

Abstract

Osteoporosis is one of the most common musculoskeletal disorders in older adults, associated not only with an increased risk of fractures but also with chronic pain, progressive disability, and a substantial economic burden on healthcare systems. The pathogenesis of chronic pain in osteoporosis is still predominantly viewed through a pharmacological paradigm, whereas the role of neuromuscular dysfunction, sarcopenia, central sensitization, and biomechanical alterations, as well as the potential for their correction through rehabilitation programs, remains insufficiently studied. This review analyzes publications mainly from 2016–2026 retrieved from PubMed, Scopus, Web of Science, the Cochrane Library, and eLibrary (clinical guidelines, meta-analyses, systematic reviews, randomized controlled trials), demonstrating that chronic pain in osteoporosis arises from vertebral compression deformities, biomechanical dysfunction, muscle weakness, sarcopenia, central sensitization, and chronic inflammation. Isolated pharmacotherapy provides only short-term analgesic effects, fails to correct functional deficits, and is associated with a high risk of adverse events in the context of polypharmacy, whereas multidisciplinary rehabilitation — including kinesiotherapy, resistance training, physiotherapy, psychotherapeutic interventions, and patient education — targets key pathogenetic mechanisms of pain and should be considered the preferred comprehensive approach to chronic pain management in patients with osteoporosis.