In Japan, three types of bisphosphonates, such as etidronate, alendronate, and risedronate, are available in the treatment of osteoporosis. The efficacy of these bisphosphonates for increasing bone mineral density (BMD) and preventing osteoporotic fractures in patients with osteoporosis has been established : etidro nate increases lumbar BMD and prevents incident vertebral fractures, while alendronate and risedronate increase lumbar and femoral neck BMD and prevent incident vertebral fractures and hip fractures. In addition, it has been reported that all of these bisphosphonates have the potential to prevent or relieve back pain in patients with spinal osteoporosis. The mechanism for the prevention or reduction in back pain in patients with osteoporosis by treatment with bisphosphonates remains uncertain, However, available evidente suggests that the prevention of deterioration of bone architecture or the reductions in bone resorption and/or production of interleukins and prostaglandins may contribute to the reduction in back pain in patients with spinal osteoporosis. Bisphosphonates may be useful agents to prevent disability in elderly osteoporotic patients by relieving osteoporosis-related back pain as well as preventing osteoporotic fractures. The aim of osteoporosis treatment should be to prevent or relieve back pain as well as to prevent osteoporotic fractures, subsequently improving quality of life (QOL).

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