Managing acute osteoporotic vertebral fractures with calcitonin

To inform family physicians of current issues in the management of acute vertebral fractures and to examine the evidence specifically supporting a role for calcitonin in ameliorating pain.

Recommendations for use of calcitonin were based primarily on a MEDLINE review of the literature for randomized, double-blind, placebo-controlled trials. The MEDLINE search was conducted from 1966 to the present using key words calcitonin, osteoporosis, pain, and vertebral fracture. Additional studies were identified by searching bibliographies of review articles. Eight trials were identified, and the conclusions drawn were based on data reported in all eight trials.

Several randomized, placebo-controlled studies demonstrated that calcitonin had a rapid onset and a strong analgesic effect on patients with acute vertebral fractures. Nasal and subcutaneous administration were both beneficial. Pain relief occurred within the first 2 weeks, could continue for at least 4 months, and might occur if treatment were instituted any time within the first year after fracture. Side effects were generally inconvenient rather than serious.

Calcitonin in a dose of 50 to 100 IU daily, given subcutaneously or intranasally, should be offered to all patients with serious pain related to acute vertebral fractures for symptom relief and to facilitate mobilization.