Is calcitonin helpful in reducing bone pain in osteoporotic fractures?
Calcitonin (suppositories, injectables and nasal spray) has been shown to significantly reduce bone pain from vertebral compression fractures more quickly than placebo immediately after a fracture (1-5). Treating patients with acute vertebral fractures with calcitonin not only decreases their pain, but also hastens their recovery by allowing them to become mobile earlier. The analgesic effect occurs within one week and is sustained over time. Analgesic dose response studies have not been done. The analgesic mechanism is unclear but some thoughts are that calcitonin elevates the concentration of beta-endorphins, directly modulates nocioception in the CNS, and alters the sensory transmission mediated by C afferent fibers.
There have not been head to head trials comparing the efficacy of calcitonin with NSAIDS or narcotics. Calcitonin has not been shown to significantly decrease bone pain in spinal stenosis or bone metastases (6,7).
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- 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: 284-9.
- Lyritis GP, Trovas G. Analgesic effects of calcitonin. Bone 2002; 30(5 Suppl.1): 71-4.
- Blau LA, Hoehns JD. Analgesic efficacy of calcitonin for vertebral fracture pain. The Annals of Pharmacotherapy 2003; 37: 564-70.
- Silverman SL, Azria M. The analgesic role of calcitonin following osteoporotic fracture. Osteoporosis Int 2002; 13: 858-867.
- Podichetty VK, Segal AM, Lieber M, Mazanec DJ. Effectiveness of salmon calcitonin nasal spray in the treatment of lumbar canal stenosis: A double-blind, randomized, placebo-controlled, parallel group trial.. Spine 2004; 29(21): 2343-2349.
- Martinez-Zapata MJ, Roque M, Alonso-Coello P, Catala E. Calcitonin for metastatic bone pain. Cochrane Database of Systematic Reviews 2006; Issue 3.