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.