Recommended Dose of Calcitonin for L1 Compression Fractures
For patients with acute osteoporotic L1 compression fractures, calcitonin should be administered at a dose of 200 IU daily for 4 weeks, either as nasal spray or as suppositories. 1
Dosing Options
- Nasal calcitonin: 200 IU (one spray) once daily is the recommended dose for pain management in vertebral compression fractures 1, 2
- Alternative administration routes:
Timing of Initiation
- Calcitonin therapy should be initiated within 0-5 days after the onset of symptoms or identifiable event for optimal pain relief 1, 3
- Early administration is critical for maximizing analgesic effect in acute vertebral compression fractures 3, 4
Duration of Treatment
- The recommended initial treatment period is 4 weeks for acute vertebral compression fractures 1, 3
- For longer-term treatment in established osteoporosis, nasal calcitonin can be administered in a 2-month-on and 2-month-off fashion for up to 12 months 1
Proper Administration of Nasal Spray
- The nasal spray pump must be primed before first use by pressing down once until a full spray is emitted 2
- Alternate nostrils daily (left nostril one day, right nostril the next) 2
- Keep the head upright during administration and tilt the bottle in a straight line with the nasal passage 2
Clinical Efficacy for Pain Management
- Pain reduction is typically observed within the first week of treatment (SMD = -1.54; 95% CI, -2.02 to -1.06) 4
- Significant pain relief continues through 4 weeks of treatment, with greater improvement in pain during mobility (SMD = -5.99,95% CI = -6.78 to -5.19) 5
- The analgesic effect facilitates early mobilization and restoration of locomotor functions such as sitting, standing, and walking 6
Adjunctive Therapy
- Calcium and vitamin D supplementation should be given concurrently with calcitonin therapy 1
- For established osteoporosis, combination therapy with calcitriol and calcium may improve bone density 1
Side Effects and Monitoring
- Side effects are generally mild and may include:
- Assessment of calcium and phosphorus levels may be advisable during treatment 1
Storage Considerations
- Before opening: Keep refrigerated between 2°C to 8°C (36°F to 46°F) 2
- After opening: Store at room temperature between 20°C to 25°C (68°F to 77°F) in an upright position 2
- Discard bottles left at room temperature for more than 35 days 2
Important Considerations
- Calcitonin is contraindicated in patients with allergy to calcitonin-salmon or synthetic calcitonin-salmon 1
- While effective for acute pain in recent vertebral fractures, calcitonin has limited evidence for chronic pain associated with older fractures 5
- The PROOF study demonstrated that 200 IU daily nasal spray reduced the risk of new vertebral fractures by 33% over 5 years 7