Calcitonin Treatment
We suggest patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms suggesting an acute injury (0-5 days after identifiable event or onset of symptoms) and who are neurologically intact be treated with calcitonin for 4 weeks.
MODERATE RECOMMENDATION Rationale
This recommendation is based on two Level II studies which showed benefit in reducing pain at 4 weeks using salmon calcitonin administered within 5 days of a fracture event.27, 28 In one study, 100 patients were treated with 200 IU nasal calcitonin or placebo. Calcitonin reduced pain in 4 positions (bedrest, sitting, standing, and walking) and the number of bedridden patients at 1, 2, 3, and 4 weeks in a clinically important manner. In a second study with 36 patients, similar results were found with calcitonin suppositories 200 IU. Side effects of calcitonin include mild dizziness.28
Two additional Level II studies with calcitonin showed benefit at longer periods of time (3-12) months but were not as well designed.29, 30 In one, possibly clinically important benefit was shown in pain reduction using nasal calcitonin in a two-month on and two month off fashion for 12 months compared to calcium 500 mg with vitamin D 200 IU.29 In another study, 200 IU nasal calcitonin led to possibly clinically important improvement in pain at 3 months when compared to 1000 mg calcium.30
The effect of subcutaneous administration of calcitonin is undetermined in a rigorous scientific manner.
Two additional Level II studies with calcitonin showed benefit at longer periods of time (3-12) months but were not as well designed.29, 30 In one, possibly clinically important benefit was shown in pain reduction using nasal calcitonin in a two-month on and two month off fashion for 12 months compared to calcium 500 mg with vitamin D 200 IU.29 In another study, 200 IU nasal calcitonin led to possibly clinically important improvement in pain at 3 months when compared to 1000 mg calcium.30
The effect of subcutaneous administration of calcitonin is undetermined in a rigorous scientific manner.
- (27) Lyritis GP, Paspati I, Karachalios T, Ioakimidis D, Skarantavos G, Lyritis PG. Pain relief from nasal salmon calcitonin in osteoporotic vertebral crush fractures. A double blind, placebo-controlled clinical study. Acta Orthop Scand Suppl 1997;275:112-114.
- (28) Lyritis GP, Ioannidis GV, Karachalios T et al. Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osteoporotic vertebral crush fractures: a prospective double-blind, randomized, placebo-controlled clinical study. Clin J Pain 1999;15(4):284-289.
- (29) Peichl P, Rintelen B, Kumpan W, Broll H. Increase of axial and appendicular trabecular and cortical bone density in established osteoporosis with intermittent nasal salmon calcitonin therapy. Gynecol Endocrinol 1999;13(1):7-14.
- (30) Papadokostakis G, Damilakis J, Mantzouranis E, Katonis P, Hadjipavlou A. The effectiveness of calcitonin on chronic back pain and daily activities in postmenopausal women with osteoporosis. Eur Spine J 2006;15(3):356-362.