In the clinical work of pain, many patients ask “Do I have osteoporosis”? This indicates that people, especially the elderly, attach great importance to this problem; but on the other hand, we often encounter many people who suffer from severe osteoporosis, so much so that they are unaware of the occurrence of thoracic and lumbar vertebral fractures and do not come to the hospital until they are in severe pain, which in turn indicates a lack of awareness of osteoporosis. First, osteoporosis has become the sixth most common disease in the world, and postmenopausal women are the main victim group. With the advent of aging society, osteoporosis has become an important health problem for human beings. According to the information in the “Guidelines for the diagnosis and treatment of primary osteoporosis (2011)”, the prevalence of osteoporosis over 60 years of age has increased significantly, and about 80% of them are postmenopausal women. The prevalence of vertebral fractures in women over 50 years of age in Beijing is 15%, equivalent to 1 in 7 women over 50 years of age having had a vertebral fracture, and the incidence of hip fractures over 50 years of age is 119 per 100,000 men and 229 per 100,000 women. Elderly women account for the majority of patients with severe pain due to osteoporosis admitted to our pain unit. Osteoporosis has the following characteristics: 1. it is “silent” and often not known until the fracture. 2, more women than men, due to the post-menopausal female hormone secretion sharply reduced, accelerating the loss of bone mass. 3, with the increase in age, the prevalence of osteoporosis has also increased. Therefore, the prevention and treatment of osteoporosis in the elderly, especially in elderly women, should be given great attention. Second, why the elderly are vulnerable to osteoporosis. Normal bone metabolism is carried out in the form of bone reconstruction. Bones are living tissues that are constantly metabolized, and old bones are absorbed and replaced by new ones. The cycle of breakdown and reconstruction maintains a relatively stable level of bone conversion in the body. When osteoclast activity > osteoblast activity, bone dissolution > bone formation, resulting in bone loss, osteoporosis occurs if bone resorption is excessive or too rapid. The reduction of sex hormone secretion in the elderly and the dysregulation of calcium-regulating hormone secretion resulting in disorders of bone metabolism are important causes of osteoporosis. In addition, due to the loss of teeth and reduced digestive function, the elderly have a lack of nutrition, resulting in insufficient intake of protein, calcium, phosphorus, vitamins and trace elements. The reduction of outdoor exercise is also one of the reasons why the elderly are prone to osteoporosis. Osteoporosis and pain The clinical manifestations of osteoporosis are mainly pain, shortening of height and hunchback, and fracture. The characteristics of pain (bone pain): 1, low back pain is the most common, 67% is limited low back pain, 10% is low back pain with striated pain, 9% is low back pain with radiating pain of extremities, 4% is low back pain with numbness of extremities. 2, dominated by resting pain or turning pain at night rest. 3, Related to the time and degree of weight bearing. 4, There is no joint redness, swelling or fluid accumulation, and the active or passive activities of limb joints are normal. If sudden onset of acute pain in the thoracolumbar back often suggests that a vertebral compression fracture may have occurred. There is obvious pressure pain in the corresponding area on physical examination. Osteoporosis pain is not easily distinguished from pain caused by chronic low back strain and osteoarthrosis, and is easily overlooked or misdiagnosed if it is not severe. Osteoporotic fractures (fragility fractures) often have no obvious history of trauma and are most commonly located in the thoracic and lumbar spine, followed by the hip. Due to compensatory spinal stability, many patients with vertebral fractures are still able to move, so they are not taken seriously. Fourth, the treatment of osteoporosis pain 1, anti-osteoporosis drugs. Bisphosphonates specifically bind to the bone surface where bone conversion is active to inhibit the function of osteoclasts, thereby inhibiting bone resorption. Calcitonin, a calcium-regulating hormone, can inhibit the biological activity of osteoclasts and reduce the number of osteoclasts, thus stopping bone loss, while significantly relieving bone pain. 1,25 bis-hydroxyvitamin D3 (osteotriol) can promote bone formation and mineralization and increase bone density. 2. Analgesic drugs. Osteoporosis with pain as the main complaint, are accompanied by varying degrees of long-term chronic pain, which seriously affects the quality of life. Therefore, in the anti-osteoporosis at the same time must pay attention to analgesic treatment. First-class anti-inflammatory analgesic or second-class analgesic tramadol, oxycodone, etc. can be used as appropriate. 3.Minimally invasive treatment of osteoporosis pain. Vertebroplasty is the injection of bone cement under pressure into the collapsed vertebral body to restore the physical characteristics of the vertebral body. Silver needle skeletal muscle release has the principle of needle analgesia and soft tissue release, which can eliminate inflammatory response, increase local blood supply and release muscle spasm. Nerve root or epidural cavity block, radiofrequency, and adriamycin neurointerventions are targeted treatments for nerve roots injured by compression of the vertebral body, which have the characteristics of rapid onset and precise analgesia.