TY - JOUR
T1 - Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures
T2 - A systematic review and meta-analysis
AU - Knopp-Sihota, J. A.
AU - Newburn-Cook, C. V.
AU - Homik, J.
AU - Cummings, G. G.
AU - Voaklander, D.
PY - 2012/1
Y1 - 2012/1
N2 - Vertebral collapse is a common fracture associated with osteoporosis. Subsequent pain may be severe and often requires medications and bed rest. Several studies have suggested the use of calcitonin for the treatment of fracture pain. We sought to determine the analgesic efficacy of calcitonin for acute and chronic pain of osteoporotic vertebral compression fractures (OVCF). We searched for randomized, placebo, and controlled trials that evaluated the analgesic efficacy of calcitonin for pain attributable to OVCFs. We performed meta-analyses to calculate standardized mean differences (SMDs) using a fixed or random effects model. The combined results from 13 trials (n=589) determined that calcitonin significantly reduced the severity of acute pain in recent OVCFs. Pain at rest was reduced by week 1 [mean difference (MD)=-3.39, 95% confidence interval (CI)=-4.02 to -2.76), with continued improvement through 4 weeks. At week 4, the difference in pain scores with mobility was even greater (SMD=-5.99, 95% CI=-6.78 to -5.19). For patients with chronic pain, there was no statistical difference between groups while at rest; there was a small, statistically significant difference between groups while mobile at 6 months (SMD=0.49, 95% CI=-0.85 to -0.13, p=0.008). Side effects were mild, with enteric disturbances and flushing reported most frequently. Although calcitonin has proven efficacy in the management of acute back pain associated with a recent OVCF, there is no convincing evidence to support the use of calcitonin for chronic pain associated with older fractures of the same origin.
AB - Vertebral collapse is a common fracture associated with osteoporosis. Subsequent pain may be severe and often requires medications and bed rest. Several studies have suggested the use of calcitonin for the treatment of fracture pain. We sought to determine the analgesic efficacy of calcitonin for acute and chronic pain of osteoporotic vertebral compression fractures (OVCF). We searched for randomized, placebo, and controlled trials that evaluated the analgesic efficacy of calcitonin for pain attributable to OVCFs. We performed meta-analyses to calculate standardized mean differences (SMDs) using a fixed or random effects model. The combined results from 13 trials (n=589) determined that calcitonin significantly reduced the severity of acute pain in recent OVCFs. Pain at rest was reduced by week 1 [mean difference (MD)=-3.39, 95% confidence interval (CI)=-4.02 to -2.76), with continued improvement through 4 weeks. At week 4, the difference in pain scores with mobility was even greater (SMD=-5.99, 95% CI=-6.78 to -5.19). For patients with chronic pain, there was no statistical difference between groups while at rest; there was a small, statistically significant difference between groups while mobile at 6 months (SMD=0.49, 95% CI=-0.85 to -0.13, p=0.008). Side effects were mild, with enteric disturbances and flushing reported most frequently. Although calcitonin has proven efficacy in the management of acute back pain associated with a recent OVCF, there is no convincing evidence to support the use of calcitonin for chronic pain associated with older fractures of the same origin.
KW - Back pain
KW - Calcitonin
KW - Osteoporosis
KW - Vertebral fractures
UR - http://www.scopus.com/inward/record.url?scp=84857364736&partnerID=8YFLogxK
U2 - 10.1007/s00198-011-1676-0
DO - 10.1007/s00198-011-1676-0
M3 - Review article
C2 - 21660557
AN - SCOPUS:84857364736
SN - 0937-941X
VL - 23
SP - 17
EP - 38
JO - Osteoporosis International
JF - Osteoporosis International
IS - 1
ER -