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Compared to limb pain of other origin, ultrasonographic osteodensitometry reveals loss of bone density in complex regional pain syndrome

Bazika-Gerasch, Bojanaa; Maier, Christophb; Kumowski, Ninab; Fiege, Carolinb; Kaisler, Miriamb; Vollert, Janb,c; Dietrich, Johannes W.a,d,*

doi: 10.1097/j.pain.0000000000001520
Research Paper
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Local osteopenia and altered bone metabolism are major complications of complex regional pain syndrome (CRPS), but quantitative assessment is difficult unless using X-ray or dual-energy X-ray absorptiometry. Ultrasound-based measurement of bone density (UBD) is a possible alternative but has never been used to detect unilateral disease such as CRPS. Therefore, the main outcome measure of this prospective study was the diagnostic utility of UBD in patients with lower-limb CRPS. Second, we compared the extent of unilateral and contralateral calcaneal bone density to that of other conditions with unilateral pain, general osteoporosis, and healthy subjects. Calcaneal osteodensitometry was bilaterally examined using ultrasound-based methodology. Bone mineral density values were converted to Z-scores based on age- and sex-dependent reference values. All patients completed a functional and an osteoporosis risk questionnaire. In patients with CRPS (n = 18), the bone mineral density values and Z-scores were significantly lower in both the affected (mean ± SD: 0.40 ± 0.08 and −1.1 ± 0.8, respectively) and nonaffected (0.46 ± 0.09 and −0.6 ± 0.9, respectively) limbs than in patients (n = 40) with other unilateral pain syndromes (affected: 0.51 ± 0.1 and −0.2 ± 1.1, respectively; nonaffected: 0.54 ± 0.11 and 0 ± 0.9, respectively) and healthy subjects (right side: 0.6 ± 0.1 and 0.1 ± 0.9, respectively). Conversely, in patients with known systemic osteoporosis, the Z-scores were lower bilaterally with smaller side-to-side differences than in those with CRPS (P < 0.05). Compared with subjects suffering from long-term CRPS (≥2.4 years), patients with shorter disease duration exhibited significantly lower Z-scores (P < 0.05). In conclusion, UBD revealed that CRPS is associated with both local and systemic alterations of bone metabolism.

Ultrasound-based measurement of bone density, a noninvasive and risk-free method, delivers physiological insights and may help to distinguish complex regional pain syndrome from pain of other origin.

aDepartment of Endocrine Research, Medical Hospital I, BG University Hospital Bergmannsheil Bochum, Bochum, Germany

bDepartment of Pain Medicine, BG University Hospital Bergmannsheil Bochum, Bochum, Germany

cPain Research, Department of Surgery and Cancer, Chelsea and Westminster Campus, Imperial College London, London, United Kingdom

dRuhr Center for Rare Diseases (CeSER), Ruhr University, Witten-Herdecke University, Bochum, Germany

Corresponding author. Address: Endocrinology and Diabetes Department, Medical Hospital I, Bergmannsheil University Hospitals, Bürkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany. Tel.: +49-234-302-6400; fax: +49-234-302-6403. E-mail address: johannes.dietrich@ruhr-uni-bochum.de (J.W. Dietrich).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received May 07, 2018

Received in revised form January 25, 2019

Accepted February 01, 2019

© 2019 International Association for the Study of Pain
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