How does calcitonin help alleviate vertebral pain?

From the Guidelines

Calcitonin is recommended for alleviating vertebral pain, particularly in patients with acute vertebral fractures caused by osteoporosis, due to its analgesic effects and ability to stabilize bone metabolism. The medication works by binding to specific receptors in the central nervous system that modulate pain perception, similar to endorphins, and inhibits osteoclast activity, which reduces bone resorption and helps stabilize fractured vertebrae 1.

Key Points

• Calcitonin can provide pain relief for patients with acute vertebral fractures, particularly those caused by osteoporosis, with a typical treatment duration of 2-4 weeks 1.
• The medication is available as a nasal spray (200 IU daily) or injection (100 IU daily subcutaneously or intramuscularly) 1.
• Patients often experience pain reduction within 1-2 weeks of starting therapy, with side effects including nausea, facial flushing, and nasal irritation with the spray formulation 1.
• While calcitonin is not a first-line treatment for chronic back pain, it can be valuable as part of a comprehensive approach to managing acute vertebral fracture pain while other treatments and bone-strengthening medications take effect 1.

Treatment Considerations

• The use of calcitonin for 4 weeks following the onset of fracture is recommended, based on a series of systematic reviews of published studies on the treatment of symptomatic osteoporotic spinal compression fractures 1.
• Calcitonin has weaker data compared to other options, such as bisphosphonates, and should be used only in women with less serious osteoporosis who cannot tolerate other treatments 1.

From the FDA Drug Label

Calcitonin-Salmon Nasal Spray, given by the intranasal route, has been shown to increase spinal bone mass in post-menopausal women with established osteoporosis Vertebral fractures occur with the highest frequency and are associated with back pain, spinal deformity and a loss of height. Calcitonin-Salmon Nasal Spray produced statistically significant increases in lumbar vertebral BMD compared to placebo as early as 6 months after initiation of therapy with persistence of this level for up to 2 years of observation.

Calcitonin helps alleviate vertebral pain by increasing spinal bone mass and reducing the risk of vertebral fractures in postmenopausal women with established osteoporosis 2, 2. This is achieved through its action on bone, where it inhibits bone resorption and may also augment bone formation. As a result, calcitonin therapy can help reduce the frequency of vertebral fractures, which are often associated with back pain, spinal deformity, and loss of height.

From the Research

Mechanism of Calcitonin in Alleviating Vertebral Pain

• Calcitonin is a naturally occurring peptide that acts via specific receptors to strongly inhibit osteoclast function, which can help reduce bone pain in osteoporotic vertebral fractures 3
• Calcitonin has been shown to have a rapid onset and a strong analgesic effect on patients with acute vertebral fractures, with pain relief occurring within the first 2 weeks and continuing for at least 4 months 4

Efficacy of Calcitonin in Treating Vertebral Pain

• Several randomized, placebo-controlled studies have demonstrated that calcitonin can reduce the severity of acute pain in recent osteoporotic vertebral compression fractures (OVCFs) 5, 6
• Calcitonin has been shown to be beneficial and safe for treating acute pain associated with compression fractures, with a number needed to treat of two 5
• The analgesic efficacy of calcitonin for chronic pain associated with older fractures is less clear, with some studies suggesting no statistical difference between groups while at rest, but a small, statistically significant difference between groups while mobile at 6 months 6

Administration and Dosage of Calcitonin

• Calcitonin can be administered intranasally or subcutaneously, with both forms being beneficial for reducing pain in acute vertebral fractures 4
• The recommended dosage of calcitonin for treating acute vertebral fractures is 50-100 IU daily, given subcutaneously or intranasally 4
• The optimal dosage and duration of calcitonin treatment for chronic pain associated with osteoporotic vertebral fractures is not well established and requires further study 3, 6

Side Effects of Calcitonin

• Calcitonin is generally well-tolerated, with mild side effects such as enteric disturbances and flushing reported most frequently 6
• The risk of adverse events, including nausea and vomiting, is low with calcitonin treatment 5