From the Guidelines
Calcitonin spray is not recommended as a primary treatment for pain relief in non-vertebral fractures, but it may be considered as an adjunctive therapy in certain cases, as evidenced by a moderate recommendation for its use in osteoporotic spinal compression fractures for 4 weeks following the onset of fracture 1. The use of calcitonin for non-vertebral fractures is less established, and its effectiveness for this specific condition is not strongly supported by the available evidence. Some key points to consider when evaluating the use of calcitonin for non-vertebral fracture pain include:
- The medication's potential to inhibit osteoclast activity and its possible direct analgesic effects through endorphin regulation
- The standard pain management approaches for non-vertebral fractures, which typically involve acetaminophen, NSAIDs, or prescribed analgesics, along with proper immobilization and physical therapy
- The potential side effects of calcitonin, including nasal irritation, rhinitis, and headache
- The importance of consulting with a healthcare provider before starting calcitonin for fracture pain management, particularly in patients who cannot tolerate standard pain medications or have inadequate pain control with conventional approaches. Given the limited evidence and potential side effects, calcitonin spray should only be considered as an adjunctive therapy for non-vertebral fracture pain relief in specific cases, and under the guidance of a healthcare provider 1.
From the FDA Drug Label
The information below, describing the clinical pharmacology of calcitonin, has been derived from studies with injectable calcitonin. Vertebral fractures occur with the highest frequency and are associated with back pain, spinal deformity and a loss of height. Calcitonin-Salmon Nasal Spray, given by the intranasal route, has been shown to increase spinal bone mass in post-menopausal women with established osteoporosis
The FDA drug label does not answer the question about relieving pain in non-vertebral fractures. The label discusses the effect of calcitonin on vertebral fractures and osteoporosis, but does not provide direct information about its use in relieving pain in non-vertebral fractures 2, 2.
From the Research
Effectiveness of Calcitonin Spray in Relieving Pain
- The analgesic effect of calcitonin in osteoporosis has been demonstrated in several studies, with evidence suggesting that it can reduce bone pain in osteoporotic patients 3.
- Calcitonin spray has been shown to be effective in relieving pain in patients with vertebral crush fractures and bone pain 3, 4.
- However, the evidence for its effectiveness in relieving pain in non-vertebral fractures is limited, with one study suggesting that calcitonin does not significantly reduce the risk of nonvertebral fractures 4.
- Other studies have investigated the use of calcitonin in relieving pain in patients with metastatic bone pain, but the evidence is limited and does not support its use for this indication 5, 6.
- A more recent review suggests that calcitonin can be a helpful analgesic agent in different painful situations, including acute pains related to vertebral fractures and neuropathic pains 7.
Mechanism of Action
- The mechanism of action of calcitonin in relieving pain is not fully understood, but it is thought to involve the endogenous opiate system and the modulation of nociception in the central nervous system 3.
- Calcitonin has been shown to bind to specific receptors in areas of the brain involved in pain perception, and its analgesic effect may be mediated by the release of beta-endorphins 3.
- Other mechanisms, such as the alteration of Na+ channel and serotonin receptor expression, have also been proposed to explain the analgesic effect of calcitonin 7.