Vertebral collapse is one of the most common fractures associated with
osteoporosis. The subsequent
back pain is severe and often requires medications,
bed rest and hospitalization to control
pain and improve mobilization. The purpose of this systematic review was to assess the effects of
calcitonin versus placebo for the treatment of
acute pain in patients sustaining stable, recent, osteoporotic vertebral
compression fractures. MEDLINE (1966-2003), EMBASE (1980-2003), Cochrane Controlled Trial Registry (2003, volume 3), other databases, and conference proceedings were searched for relevant research. Primary study authors and the
pharmaceutical manufacturer were contacted, and bibliographies of relevant papers were hand-searched. Randomized, double-blind, placebo-controlled trials comparing
calcitonin versus placebo for the
acute pain of recent osteoporotic vertebral
compression fractures were included. Two reviewers extracted data, performed numeric calculations and extrapolated graphical data independently. The combined results from five randomized controlled trials, involving 246 patients, determined that
calcitonin significantly reduced the severity of
pain using a visual analogue scale following diagnosis.
Pain at rest was reduced as early as 1 week into treatment (weighted mean difference [WMD] =3.08; 95% confidence interval [CI]: 2.64, 3.52) and this effect continued weekly to 4 weeks (WMD =4.03; 95% CI: 3.70, 4.35). A similar pattern was seen for
pain scores associated with sitting, standing, and walking. Side effects were gastrointestinal, minor and often self-limited.
Calcitonin appears to be effective in the management of
acute pain associated with acute osteoporotic vertebral
compression fractures by shortening time to mobilization.