What are the best treatments for reducing osteoporotic compression fracture pain?
EVIDENCE-BASED ANSWER:
Vertebral augmentation with vertebroplasty or balloon kyphoplasty yields a small reduction in both acute and chronic pain scores in adults with osteoporotic compression fractures compared with conservative therapy or sham treatment (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials [RCTs]).
When compared with placebo, usual treatment, or other analgesia, calcitonin reduces the severity and duration of pain at rest and with mobility 1 week after an osteoporotic compression fracture and with mobility at 6 months postfracture (SOR: B, meta-analysis of RCTs).
Calcitonin was administered in varying doses by various routes (200 IU intranasal, 50-200 IU intramuscular or subcutaneous injection, or 200 IU rectal suppository) and compared with placebo, usual treatment, or other analgesia. The VAS was varied (10 cm, 100 mm, or 5-point) and assessed pain and length of time to mobilization with patients at rest, sitting, standing, and walking by using mean deviation (MD) and SMD.
In the acute phase, calcitonin resulted in greater pain relief 1 week after fracture at rest (4 trials; 260 patients; 10-cm VAS; MD=−3.4; 95% CI, −4 to −2.8) and with walking (4 trials, 228 patients; SMD=2.6; 95% CI, −4.1 to −1.1) compared with the control group. At 6 months, calcitonin had reduced pain in mobile patients more than in the control group (7 trials, 207 patients; SMD=−0.5; 95% CI, −0.9 to −0.1).
Statistically significant adverse effects of calcitonin included gastrointestinal disturbances and flushing compared with placebo. Adverse effects were more predominant in the studies that used injectable calcitonin and in the chronic pain group. The study is considered low-quality because of increased heterogeneity in the acute pain studies.
