Archives of Osteoporosis

, 11:34 | Cite as

Effects of acupuncture on quality of life and pain in patients with osteoporosis—a pilot randomized controlled trial

  • Joerg Schiller
  • Christoph Korallus
  • Matthias Bethge
  • Matthias Karst
  • Marie-Lena Schmalhofer
  • Christoph Gutenbrunner
  • Matthias Georg Fink
Original Article



In this sham-controlled study, 53 patients received 10 sessions of acupuncture treatment over 5 weeks to investigate the effects of acupuncture on the pain and quality of life of patients with osteoporosis. The results showed significant favorable effects of verum acupuncture on quality of life. Both interventions showed sustained and clinically relevant effects on pain.


Standard analgesic treatment is associated with adverse events in patients with osteoporosis, especially elderly and/or comorbid patients. As acupuncture has gained widespread acceptance as a complementary treatment modality with few side effects, the aim of this study was to evaluate the effects of acupuncture on the pain and quality of life of patients with osteoporosis.


In total, 53 patients with vertebral compression fractures, osteoporosis-associated spinal deformities, and resultant pain were randomly allocated to the verum acupuncture with deep needling of specific points following the principles of traditional Chinese medicine (n = 29) or control acupuncture group with superficial needling of non-acupuncture points (n = 24). All patients received 10 sessions of standardized verum or control acupuncture treatment over 5 weeks. Pain (VAS score 1–100) and quality of life (QUALEFFO-41) were measured at the start of treatment (T0), before each acupuncture session (T1), and at 1 (T2) and 3 months (T3) post-treatment.


Both acupuncture treatments significantly reduced activity-related pain and pain at rest over time. The verum acupuncture group experienced a significantly greater reduction in mean pain intensity at rest than the control group. In the control group, quality of life improved only temporarily post-treatment (T2) and slightly declined at the end of the follow-up period (T3). In contrast, patients in the verum acupuncture group experienced continuous and significant improvements in quality of life up to 3 months after treatment (T3).


Both types of acupuncture were equally effective in producing sustained, clinically relevant pain relief in patients with osteoporosis. Verum acupuncture had stronger and longer-lasting effects on quality of life and pain at rest. The possible reasons for these findings include the specificity of acupuncture point selection and the performance of needle stimulation.


Osteoporosis Acupuncture Pain Quality of life QUALEFFO-41 



The authors thank C. Korallus for the strong commitment and support in the drafting of this manuscript, M. Bethge for the excellent statistical analyses, D. Dörffer and M. Schmalhofer for entering the data, H. Rahne for practical assistance in the pre- and post-follow-up sessions, and M. Karst and C. Gutenbrunner for their comprehensive revision of the article. We also thank the patients whose participation made this project possible.

Compliance with ethical standards

Conflicts of interest



  1. 1.
    Cockerill W, Lunt M, Silman AJ et al (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119CrossRefPubMedGoogle Scholar
  2. 2.
    Fechtenbaum J, Cropet C, Kolta S, Horlait S, Orcel P, Roux C (2005) The severity of vertebral fractures and health-related quality of life in osteoporotic postmenopausal women. Osteoporos Int 16:2175–2179CrossRefPubMedGoogle Scholar
  3. 3.
    Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16:447–455CrossRefPubMedGoogle Scholar
  4. 4.
    Fink HA, Ensrud KE, Nelson DB, Kerani RP, Schreiner PJ, Zhao Y, Cummings SR, Nevitt MC (2003) Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT). Osteoporos Int 14:69–76CrossRefPubMedGoogle Scholar
  5. 5.
    Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674CrossRefPubMedGoogle Scholar
  6. 6.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112CrossRefPubMedGoogle Scholar
  7. 7.
    Marcovitz PA, Tran HH, Franklin BA, O’Neill WW, Yerkey M, Boura J, Kleerekoper M, Dickinson CZ (2005) Usefulness of bone mineral density to predict significant coronary artery disease. Am J Cardiol 96:1059–1063CrossRefPubMedGoogle Scholar
  8. 8.
    Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673CrossRefPubMedGoogle Scholar
  9. 9.
    Carbone LD, Johnson KC, Robbins J, Larson JC, Curb JD, Watson K, Gass M, Lacroix AZ (2010) Antiepileptic drug use, falls, fractures, and BMD in postmenopausal women: findings from the women’s health initiative (WHI). J Bone Miner Res 25:873–881PubMedGoogle Scholar
  10. 10.
    Tamblyn R, Abrahamowicz M, du Berger R, McLeod P, Bartlett G (2005) A 5-year prospective assessment of the risk associated with individual benzodiazepines and doses in new elderly users. J Am Geriatr Soc 53:233–241CrossRefPubMedGoogle Scholar
  11. 11.
    Wagner AK, Zhang F, Soumerai SB, Walker AM, Gurwitz JH, Glynn RJ, Ross-Degnan D (2004) Benzodiazepine use and hip fractures in the elderly: who is at greatest risk? Arch Intern Med 164:1567–1572CrossRefPubMedGoogle Scholar
  12. 12.
    Wu Q, Liu J, Gallegos-Orozco JF, Hentz JG (2010) Depression, fracture risk, and bone loss: a meta-analysis of cohort studies. Osteoporos Int 21:1627–1635CrossRefPubMedGoogle Scholar
  13. 13.
    Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S, Irnich D, Walther HU, Melchart D, Willich SN (2006) Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 166:450–457PubMedGoogle Scholar
  14. 14.
    Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, Liecker B, Linde K, Wegscheider K, Willich SN (2006) Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 164:487–496CrossRefPubMedGoogle Scholar
  15. 15.
    Haake M, Muller HH, Schade-Brittinger C, Basler HD, Schafer H, Maier C, Endres HG, Trampisch HJ, Molsberger A (2007) German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med 167:1892–1898CrossRefPubMedGoogle Scholar
  16. 16.
    Brinkhaus B, Witt CM, Jena S et al (2006) Interventions and physician characteristics in a randomized multicenter trial of acupuncture in patients with low-back pain. J Altern Complement Med 12:649–657CrossRefPubMedGoogle Scholar
  17. 17.
    Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH (1990) Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 17:1022–1024PubMedGoogle Scholar
  18. 18.
    Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA (1978) Studies with pain rating scales. Ann Rheum Dis 37:378–381CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Todd KH, Funk KG, Funk JP, Bonacci R (1996) Clinical significance of reported changes in pain severity. Ann Emerg Med 27:485–489CrossRefPubMedGoogle Scholar
  20. 20.
    Lips P, Agnusdei D, Caulin F et al (1996) The development of a European questionnaire for quality of life in patients with vertebral osteoporosis. Scand J Rheumatol Suppl 103:84–85 discussion 86-88CrossRefPubMedGoogle Scholar
  21. 21.
    Oleksik AM, Ewing S, Shen W, van Schoor NM, Lips P (2005) Impact of incident vertebral fractures on health related quality of life (HRQOL) in postmenopausal women with prevalent vertebral fractures. Osteoporos Int 16:861–870CrossRefPubMedGoogle Scholar
  22. 22.
    Lips P, Cooper C, Agnusdei D et al (1997) Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporos Int 7:36–38CrossRefPubMedGoogle Scholar
  23. 23.
    Rabe-Hesketh S, Everitt BS (2004) A handbook of statistical analyses using stata. CRC Press, Boca RatonGoogle Scholar
  24. 24.
    Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150:971–979CrossRefPubMedGoogle Scholar
  25. 25.
    Weidenhammer W, Linde K, Streng A, Hoppe A, Melchart D (2007) Acupuncture for chronic low back pain in routine care: a multicenter observational study. Clin J Pain 23:128–135CrossRefPubMedGoogle Scholar
  26. 26.
    Gewandter JS, Dworkin RH, Turk DC et al (2014) Research designs for proof-of-concept chronic pain clinical trials: IMMPACT recommendations. Pain 155:1683–1695CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Paolucci T, Saraceni VM, Piccinini G (2016) Management of chronic pain in osteoporosis: challenges and solutions. J Pain Res 9:177–186CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Quante S (2010) Wirksamkeit und Akzeptanz der Akupunktur bei Patienten mit chronischen Rückenschmerzen-Ergebnisse einer prospektiven, randomisierten Studie. Med. Diss. Universität GöttingenGoogle Scholar
  29. 29.
    Usichenko TI, Dinse M, Hermsen M, Witstruck T, Pavlovic D, Lehmann C (2005) Auricular acupuncture for pain relief after total hip arthroplasty—a randomized controlled study. Pain 114:320–327CrossRefPubMedGoogle Scholar
  30. 30.
    Wetzel B, Pavlovic D, Kuse R, Gibb A, Merk H, Lehmann C, Wendt M, Usichenko TI (2011) The effect of auricular acupuncture on fentanyl requirement during hip arthroplasty: a randomized controlled trial. Clin J Pain 27:262–267CrossRefPubMedGoogle Scholar
  31. 31.
    Usichenko TI, Dinse M, Lysenyuk VP, Wendt M, Pavlovic D, Lehmann C (2006) Auricular acupuncture reduces intraoperative fentanyl requirement during hip arthroplasty—a randomized double-blinded study. Acupunct Electrother Res 31:213–221CrossRefPubMedGoogle Scholar
  32. 32.
    Streng A, Linde K, Hoppe A, Pfaffenrath V, Hammes M, Wagenpfeil S, Weidenhammer W, Melchart D (2006) Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Headache 46:1492–1502CrossRefPubMedGoogle Scholar
  33. 33.
    Zheng Z, Guo RJ, Helme RD, Muir A, Da Costa C, Xue CC (2008) The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: a pilot randomized controlled clinical trial. Eur J Pain 12:671–676CrossRefPubMedGoogle Scholar
  34. 34.
    Fink MG, Kunsebeck H, Wipperman B, Gehrke A (2001) Non-specific effects of traditional Chinese acupuncture in osteoarthritis of the hip. Complement Ther Med 9:82–89CrossRefPubMedGoogle Scholar
  35. 35.
    Fink MG, Kunsebeck HW, Wippermann B (2000) Effect of needle acupuncture on pain perception and functional impairment of patients with coxarthrosis. Z Rheumatol 59:191–199CrossRefPubMedGoogle Scholar
  36. 36.
    Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K (2012) Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 172:1444–1453CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S (2008) Effectiveness of acupuncture for low back pain: a systematic review. Spine 33:E887–E900CrossRefPubMedGoogle Scholar
  38. 38.
    Kim DH, Vaccaro AR (2006) Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 6:479–487CrossRefPubMedGoogle Scholar
  39. 39.
    Fernandez-de-las-Penas C, Hernandez-Barrera V, Alonso-Blanco C, Palacios-Cena D, Carrasco-Garrido P, Jimenez-Sanchez S, Jimenez-Garcia R (2011) Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine 36:E213–E219CrossRefPubMedGoogle Scholar
  40. 40.
    Chou YC, Shih CC, Lin JG, Chen TL, Liao CC (2013) Low back pain associated with sociodemographic factors, lifestyle and osteoporosis: a population-based study. J Rehabil Med 45:76–80CrossRefPubMedGoogle Scholar
  41. 41.
    Sinaki M, Pfeifer M, Preisinger E, Itoi E, Rizzoli R, Boonen S, Geusens P, Minne HW (2010) The role of exercise in the treatment of osteoporosis. Curr Osteoporos Rep 8:138–144CrossRefPubMedGoogle Scholar
  42. 42.
    Nagae M, Hiraga T, Wakabayashi H, Wang L, Iwata K, Yoneda T (2006) Osteoclasts play a part in pain due to the inflammation adjacent to bone. Bone 39:1107–1115CrossRefPubMedGoogle Scholar
  43. 43.
    Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456CrossRefPubMedGoogle Scholar
  44. 44.
    Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800CrossRefPubMedGoogle Scholar
  45. 45.
    Matthis C, Weber U, O’Neill TW, Raspe H (1998) Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS). Osteoporos Int 8:364–372CrossRefPubMedGoogle Scholar
  46. 46.
    Bowsher D (1990) Physiology an pathophysiology of pain. Acupunct Med 7:17–20CrossRefGoogle Scholar
  47. 47.
    Le Bars D, Dickenson AH, Besson JM (1979) Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain 6:283–304CrossRefPubMedGoogle Scholar
  48. 48.
    Le Bars D, Dickenson AH, Besson JM (1979) Diffuse noxious inhibitory controls (DNIC). II. Lack of effect on non-convergent neurones, supraspinal involvement and theoretical implications. Pain 6:305–327CrossRefPubMedGoogle Scholar
  49. 49.
    Lundeberg T, Lund I, Sing A, Naslund J (2011) Is placebo acupuncture what it is intended to be? Evid Based Complement Alternat Med 2011:932407CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    White A (2009) Western medical acupuncture: a definition. Acupunct Med 27:33–35CrossRefPubMedGoogle Scholar
  51. 51.
    Myers SS, Phillips RS, Davis RB et al (2008) Patient expectations as predictors of outcome in patients with acute low back pain. J Gen Intern Med 23:148–153CrossRefPubMedGoogle Scholar
  52. 52.
    Wasan AD, Kong J, Pham LD, Kaptchuk TJ, Edwards R, Gollub RL (2010) The impact of placebo, psychopathology, and expectations on the response to acupuncture needling in patients with chronic low back pain. J Pain 11:555–563CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • Joerg Schiller
    • 1
  • Christoph Korallus
    • 1
  • Matthias Bethge
    • 1
    • 2
  • Matthias Karst
    • 3
  • Marie-Lena Schmalhofer
    • 1
  • Christoph Gutenbrunner
    • 1
  • Matthias Georg Fink
    • 1
  1. 1.Department of Rehabilitation MedicineHannover Medical SchoolHannoverGermany
  2. 2.Institute of Social Medicine and Epidemiology, Section Rehabilitation and WorkUniversity of LübeckLübeckGermany
  3. 3.Department of Anesthesiology and Intensive Care MedicineHannover Medical SchoolHannoverGermany

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