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Kaneb A, Berardino K, Hanukaai JS, Rooney K, Kaye AD. Calcitonin (FORTICAL, MIACALCIN) for the treatment of vertebral compression fractures. Orthop Rev (Pavia) 2021; 13:24976. [PMID: 34745472 DOI: 10.52965/001c.24976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose of Review Osteoporosis is a common condition affecting the musculoskeletal system. It carries with it increased risks of fracture in many areas of the body, leading to reduced quality of life, limited mobility, and other long-term implications such as chronic pain. Vertebral compression fractures are a common development in patients with osteoporosis. Current treatment options focus on reducing pain; preventative methods are somewhat limited and focus on minimizing risk factors for the development of osteoporosis. In this review, we explore the use of calcitonin (FORTICAL, MIACALCIN) to treat vertebral compression fractures (VCFs). Recent Findings Osteoporosis had a prevalence of more than 10% in the United States in 2010. The CDC estimates that nearly 25% of women over age 65 have findings of osteoporosis, which include low spinal bone mass. The condition is highly prevalent and, in an aging U.S. population, quite clinically relevant. Risk factors for development include advanced age, cigarette smoking, medications, reduced physical activity, and low calcium and vitamin D intake. Family history may also play a role. Diagnosis is made based on bone mineral density.Standard therapy for VCFs in osteoporosis includes analgesic medications, such as NSAIDs and biphosphonates, and surgical intervention. NSAIDs address the chronic pain that is a common long-term effect of VCFs. Biphosphonates have recently been used to attempt to halt the progression and provide prevention. Surgical interventions such as balloon kyphoplasty and vertebroplasty are typically reserved for patients who have failed other methods.Calcitonin is a peptide naturally produced by the human body, released from the parathyroid gland. It binds to osteoclasts, inhibiting them from inducing bone resorption. By relatively unknown mechanisms, it also appears to cause endorphin release and mitigate pain. Clinical data has shown safety and efficacy for exogenous calcitonin in reducing bone turnover and reducing VCF-induced pain. Summary Osteoporosis is a common condition that can lead to complications such as vertebral compression fractures. It can significantly impact the quality of life in many elderly Americans. There is currently no singular treatment, but calcitonin has recently been explored as a possible option for minimizing pain and reducing disease progression. Further studies are needed to understand its preventative benefits fully.
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Affiliation(s)
- Alicia Kaneb
- Georgetown University School of Medicine, Washington D.C
| | | | | | - Kelsey Rooney
- Louisiana State University Health Science Center, Shreveport, LA
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Gou Y, Tian F, Dai M, Li H, Lv Q, Kong Q, Chen T, Shao L, Song H, Zhang Y, Zhang L. Salmon calcitonin exerts better preventive effects than celecoxib on lumbar facet joint degeneration and long-term tactile allodynia in rats. Bone 2019; 127:17-25. [PMID: 30826485 DOI: 10.1016/j.bone.2019.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/06/2019] [Accepted: 02/26/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate and compare the effects of salmon calcitonin (sCT) and celecoxib (CLX) on cartilage, subchondral bone and tactile allodynia in a rat model of lumbar facet joint (FJ) osteoarthritis (OA). METHOD Forty 3-month-old male Sprague-Dawley rats were randomly divided into four groups: 30 received surgical collagenase (type II) injections in the right L3-L6 facet joints followed by 8 weeks of treatment with normal saline, CLX or sCT, and the other 10 received sham surgery. Tactile allodynia, changes of cartilage and subchondral bone of the L4-L5 FJs, and serum biomarkers were analyzed for all rats. RESULTS Both sCT and CLX ameliorated cartilage lesions, significantly increased aggrecan expression and decreased caspase-3 expression. sCT also decreased the expression of a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4). According to the micro-computed tomography (micro-CT) analysis, sCT significantly improved microarchitecture parameters of subchondral bone and micro-CT score; and inhibited articular process hypertrophy. CLX showed better antihyperalgesic effects than sCT on days 3 and 7 postoperatively despite no statistical differences, whereas sCT possessed better analgesic effects than CLX on days 42 and 56. Besides, the sCT treatment reduced the elevated cartilage oligomeric matrix protein (COMP) concentration in rats injected with collagenase (type II). CONCLUSIONS Both sCT and CLX exerted preventive effects on FJ OA caused by collagenase (type II), but sCT showed more protective effects, particularly on maintaining cartilage metabolism, restraining the deterioration of the subchondral bone microarchitecture and tactile allodynia, and reducing serum COMP concentrations.
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Affiliation(s)
- Yu Gou
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China; Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China
| | - Faming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, China
| | - Muwei Dai
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China
| | - Hetong Li
- Department of Orthopedic Surgery, the Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Qinglie Lv
- Department of Orthopedic Surgery, the Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Qingfu Kong
- Department of Orthopedic Surgery, the Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Tiangang Chen
- Department of Orthopedic Surgery, the Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Litao Shao
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China; Medical Research Center, North China University of Science and Technology, Tangshan, China
| | - Huiping Song
- Department of Orthopedic Surgery, the Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Yingze Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, China; Department of Orthopedic Surgery, Meitan General Hospital, Beijing, China.
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Colquhoun L, Shepherd V, Neil M. Pain management in new amputees: a nursing perspective. ACTA ACUST UNITED AC 2019; 28:638-646. [PMID: 31116597 DOI: 10.12968/bjon.2019.28.10.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Phantom limb pain (PLP) is a widespread and challenging neuropathic pain problem, occurring after both surgical and traumatic amputation of a limb. It may occur immediately after surgery or some months later, however, most cases it presents within the first 7 postoperative days. Patients report a range of pain characteristics in the absent limb, including burning, cramping, tingling and electric shock sensation. The incidence of PLP has been reported to be between 50% and 85% following amputation. Its management is notoriously difficult, with no clear consensus on optimal treatment. It is often resistant to classic balanced analgesia and typical neuropathic pain medications. Taking into account these issues, the authors aimed to improve the management of patients undergoing amputation at their institution, by ensuring accurate and holistic assessment, the selection of suitable interventions through critical analysis and synthesis of available evidence, and the appropriate evaluation and adaptation of treatment plans, to ensure patients achieved their individualised goals.
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Affiliation(s)
- Liz Colquhoun
- Senior Pain Nurse Specialist, NHS Tayside Pain Service, Ninewells Hospital, Dundee
| | - Val Shepherd
- Senior Pain Nurse Specialist, NHS Tayside Pain Service, NHS Tayside, Dundee
| | - Michael Neil
- Consultant in Anaesthetics and Pain Medicine, NHS Tayside Pain Service, NHS Tayside, Dundee
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Adeyemi WJ, Olayaki LA. Effects of salmon calcitonin and omega – 3 fatty acids on selected biomarkers in experimental diabetic – osteoarthritic rats. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.synres.2018.100045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Guan L, Lin S, Yan W, Chen L, Wang X. Effects of calcitonin on orthodontic tooth movement and associated root resorption in rats. Acta Odontol Scand 2017; 75:595-602. [PMID: 28814141 DOI: 10.1080/00016357.2017.1365375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Our main aim was to evaluate the effects of calcitonin (CT) on orthodontic tooth movement (OTM) and orthodontic root resorption in a rat model. MATERIAL AND METHODS Eighty male Wistar rats were randomly divided into five groups. Rats in the negative control group were not given any appliances or injections. All the remaining rats were used to establish a model of OTM. The positive control group were then injected with normal saline, while rats in the three experimental groups were injected with 0.2 IU, 1 IU or 5 IU/kg/day CT. Nickel-titanium closed-coil springs were used to deliver an initial 50 g mesial force to the left maxillary first molar for 14 days in rats in the positive control group and the experimental groups. Each group was randomly subdivided into two groups, one for analysis of tooth movement, tissue changes and tartrate-resistant acid phosphatase (TRAP)-positive cells in alveolar bone, the other to examine root resorption by scanning electron microscopy. RESULTS The OTM distance, the number of force-induced osteoclasts and root resorption areas were significantly decreased in CT-injected rats in a dose-dependent manner. CONCLUSIONS Administration of CT reduces the root resorption area and may therefore be effective as a novel adjunctive orthodontic approach to diminish undesired tooth movement via enhancing anchorage or preventing relapse after OTM.
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Affiliation(s)
- Ling Guan
- Department of Orthodontics, First Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Suai Lin
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital Harbin Medical University, Harbin, P.R. China
| | - Weijun Yan
- Department of Orthodontics, First Affiliated Hospital, Harbin Medical University, Harbin, P.R. China
| | - Lei Chen
- Department of Stomatology, The Fifth Hospital of Harbin, Harbin, P.R. China
| | - Xiaofeng Wang
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital Harbin Medical University, Harbin, P.R. China
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Effect of Intranasal Calcitonin in a Patient with McCune-Albright Syndrome, Fibrous Dysplasia, and Refractory Bone Pain. Case Rep Endocrinol 2017; 2017:7898713. [PMID: 28676838 PMCID: PMC5476898 DOI: 10.1155/2017/7898713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 12/28/2022] Open
Abstract
McCune-Albright syndrome (MAS) is a rare disease defined by the triad of polyostotic fibrous dysplasia of bone, café-au-lait skin spots, and precocious puberty. No available treatment is effective in changing the course of fibrous dysplasia of bone, but symptomatic patients require therapeutic support to reduce bone pain and prevent fractures and deformities. We report the case of a 27-year-old woman with MAS and severe fibrous dysplasia. She was diagnosed with MAS at 4 years of age and, during follow-up, she had multiple pathological fractures and bone pain refractory to treatment with bisphosphonates, tricyclic antidepressants, and opioids. The pain was incapacitating and the patient required a wheelchair. Intranasal calcitonin was then started, and, 30 days later, the patient already showed significant improvement in pain severity at the affected sites. After 3 months, she was able to walk without assistance. No adverse effects were observed, nor were any significant changes in serum levels of calcium, phosphorus, and alkaline phosphatase. Calcitonin has a well-recognized analgesic effect on bone tissue. Despite the small number of studies involving patients with MAS, calcitonin may be considered a short-term therapeutic option in cases of severe and refractory bone pain.
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Yeh CB, Weng SJ, Chang KW, Chan JYH, Huang SM, Chu TH, Wei NK, Ma HS, Cheng JT, Ma KH, Chen TH, Shyu JF. Calcitonin alleviates hyperalgesia in osteoporotic rats by modulating serotonin transporter activity. Osteoporos Int 2016; 27:3355-3364. [PMID: 27260496 DOI: 10.1007/s00198-016-3652-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 05/24/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED Calcitonin may relieve pain by modulating central serotonin activity. Calcitonin partly reversed the hypersensitivity to pain induced by ovariectomy. This suggests that the anti-nociceptive effects of calcitonin in the treatment of osteoporosis may be mediated by alterations in neural serotonin transporter (SERT) activity. INTRODUCTION This study used a rat model of osteoporosis to evaluate the role of the cerebral serotonin system in the anti-nociceptive effect of calcitonin, a drug used to treat post-menopausal osteoporosis. METHODS Osteoporosis was induced in rats by ovariectomy (OVX). Rats were then randomized to the following four groups: sham operation, OVX, OVX plus calcitonin, or OVX plus alendronate. RESULTS OVX led to alterations in bone micro-architecture; alendronate strongly reversed this effect, and calcitonin moderately reversed this effect. OVX increased hyperalgesia (determined as the time for hind paw withdrawal from a heat source); calcitonin reduced this effect, but alendronate had no effect. OVX increased the expression of c-Fos (a neuronal marker of pain) in the thalamus; calcitonin strongly reversed this effect, and alendronate moderately reversed this effect. OVX also reduced SERT but increased 5-HT1A receptor expression and activity; calcitonin aggravated this effect, but alendronate had no effect on recovery of SERT/5-HT1A activity and expression. CONCLUSIONS Our study of a rat model of osteoporosis suggests that OVX-induced enhancement of the serotonergic system may protect against hyperalgesia. However, the anti-nociceptive effects of calcitonin in osteoporosis may be mediated by decreased neural SERT activity and increased activation of 5-HT1 receptors in the thalamus.
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Affiliation(s)
- C-B Yeh
- Department of Psychiatry, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - S-J Weng
- Department of Biology and Anatomy, National Defense Medical Center, 161 Ming Chuan E. Road Section 6, Taipei, Taiwan, 114, People's Republic of China
| | - K-W Chang
- Atomic Energy Council, Executive Yuan, Institute of Nuclear Energy Research, Taoyuan, Taiwan
| | - J Y-H Chan
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - S-M Huang
- Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan
| | - T-H Chu
- Department of Biology and Anatomy, National Defense Medical Center, 161 Ming Chuan E. Road Section 6, Taipei, Taiwan, 114, People's Republic of China
| | - N-K Wei
- Department of Biology and Anatomy, National Defense Medical Center, 161 Ming Chuan E. Road Section 6, Taipei, Taiwan, 114, People's Republic of China
| | - H-S Ma
- Department of Biology and Anatomy, National Defense Medical Center, 161 Ming Chuan E. Road Section 6, Taipei, Taiwan, 114, People's Republic of China
| | - J-T Cheng
- Department of Biology and Anatomy, National Defense Medical Center, 161 Ming Chuan E. Road Section 6, Taipei, Taiwan, 114, People's Republic of China
| | - K-H Ma
- Department of Biology and Anatomy, National Defense Medical Center, 161 Ming Chuan E. Road Section 6, Taipei, Taiwan, 114, People's Republic of China
| | - T-H Chen
- School of Medicine, Institute of Anatomy and Cell Biology, National Yang Ming University, Taipei, Taiwan
- Department of Surgery, Veteran General Hospital, Taipei, Taiwan
| | - J-F Shyu
- Department of Biology and Anatomy, National Defense Medical Center, 161 Ming Chuan E. Road Section 6, Taipei, Taiwan, 114, People's Republic of China.
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Wen ZH, Tang CC, Chang YC, Huang SY, Lin YY, Hsieh SP, Lee HP, Lin SC, Chen WF, Jean YH. Calcitonin attenuates cartilage degeneration and nociception in an experimental rat model of osteoarthritis: role of TGF-β in chondrocytes. Sci Rep 2016; 6:28862. [PMID: 27345362 PMCID: PMC4921823 DOI: 10.1038/srep28862] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/06/2016] [Indexed: 12/19/2022] Open
Abstract
We investigated the role of the calcitonin (Miacalcin) in the progression of osteoarthritis (OA) and in nociceptive behavior in an experimental rat model of OA and osteoporosis. OA was induced by anterior cruciate ligament transection (ACLT) of the right knee and by bilateral ovariectomy (OVX) in Wistar rats. Nociceptive behaviors (secondary mechanical allodynia and weight-bearing distribution of the hind paws) were analyzed prior to surgery and every week, beginning at 12 weeks after surgery, up to 20 weeks. At 20 weeks, histopathological studies were performed on the cartilage of the knee joints. Immunohistochemical analysis was performed to examine the effect of calcitonin on transforming growth factor (TGF)-β1 expression in articular cartilage chondrocytes. Rats subjected to ACLT + OVX surgery showed obvious OA changes in the joints. Animals subjected to ACLT + OVX and treated with calcitonin showed significantly less cartilage degeneration and improved nociceptive tests compared with animals subjected to ACLT + OVX surgeries alone. Moreover, calcitonin increased TGF-β1 expression in chondrocytes in ACLT + OVX-affected cartilage. Subcutaneous injection of calcitonin (1) attenuated the development of OA, (2) concomitantly reduced nociception, and (3) modulated chondrocyte metabolism, possibly by increasing cellular TGF-β1 expression.
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Affiliation(s)
- Zhi-Hong Wen
- Department of Marine Biotechnology &Resources, and Center for Translational Biopharmaceuticals, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chi-Chieh Tang
- Department of Early Childhood Education, National Pintung University, Taiwan
| | - Yi-Chen Chang
- Department of Marine Biotechnology &Resources, and Center for Translational Biopharmaceuticals, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Shi-Ying Huang
- Department of Marine Biotechnology &Resources, and Center for Translational Biopharmaceuticals, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yen-You Lin
- Department of Marine Biotechnology &Resources, and Center for Translational Biopharmaceuticals, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Shih-Peng Hsieh
- Section of Pathology, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Hsin-Pai Lee
- Section of Pathology, Pingtung Christian Hospital, Pingtung, Taiwan.,Department of Orthopedic Surgery, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Sung-Chun Lin
- Section of Pathology, Pingtung Christian Hospital, Pingtung, Taiwan.,Department of Orthopedic Surgery, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Wu-Fu Chen
- Department of Orthopedic Surgery, Pingtung Christian Hospital, Pingtung, Taiwan.,Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
| | - Yen-Hsuan Jean
- Department of Orthopedic Surgery, Pingtung Christian Hospital, Pingtung, Taiwan
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Abstract
Vertebral compression fractures (VCF's) are the most common form of osteoporotic fractures. Whether symptomatic or asymptomatic, they both represent a high risk for not only vertebral but also nonvertebral fractures in untreated populations. This high risk of future fracture after a VCF is independent of the T-score because bone strength is a combination of bone mineral density and bone quality. VCFs are the single greatest risk for future fractures at all other skeletal sites in untreated populations, including hip fractures. They are often unrecognized despite their exceptionally high prevalence in all genders and most ethnic groups as age increases. This article highlights some of the key messages about VCF's, and how assessment for their presence and then management will reduce the risk of all osteoporotic fractures.
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Affiliation(s)
- Paul D Miller
- Medical Director, Colorado Center for Bone Research, Lakewood, CO, USA.
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Aghazadeh-Habashi A, Yang Y, Tang K, Lőbenberg R, Doschak MR. Transdermal drug delivery: feasibility for treatment of superficial bone stress fractures. Drug Deliv Transl Res 2015; 5:540-51. [DOI: 10.1007/s13346-015-0257-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Aksoy D, Solmaz V, Erbas O. Positive effect of calcitonin on the seizures induced by pentylenetetrazole in rats. Epilepsy Res 2014; 108:390-5. [PMID: 24548550 DOI: 10.1016/j.eplepsyres.2014.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/27/2013] [Accepted: 01/20/2014] [Indexed: 01/14/2023]
Abstract
There are many difficulties involved with the treatment of epilepsy, and these problems have driven the search for new agents to control epileptic seizures. Calcitonin is a peptide hormone that has been well studied and shown to have a positive effect on neuropathic and chronic pain. The mechanism by which calcitonin affects these pain syndromes is thought to be similar to the effect of antiepileptic drugs, such as pregabalin, gabapentin and carbamazepine. In this study, we aim to investigate the effects of calcitonin on seizures induced by pentylenetetrazole (PTZ) in rats. The rats were divided into four groups. The first group was the control group, and the rats were given no medications. The second group was given saline+PTZ. The third group was given 50IU/kg calcitonin+PTZ, and the fourth group was given 100IU/kg calcitonin+PTZ. EEG traces, Racine's convulsion stages and the time of onset of the first myoclonic jerk were compared between the groups. Between the groups, there were significant differences in the Racine's convulsion stages, the onset of the 'first myoclonic jerk', and the rate of the spikes in the EEG traces. The differences were more pronounced in the 100IU/kg calcitonin-treated group (p<0.001). It has been stated that calcitonin relieves pain via regulating voltage-gated Ca(2+) and/or Na(+) channels. Calcitonin has a positive effect on convulsions in epileptic rats, possibly using the same mechanisms as is used in the treatment of neuropathic and chronic pain.
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Affiliation(s)
- Durdane Aksoy
- Gaziosmanpasa University Faculty of Medicine, Department of Neurology, Tokat, Turkey.
| | - Volkan Solmaz
- Gaziosmanpasa University Faculty of Medicine, Department of Neurology, Tokat, Turkey
| | - Oytun Erbas
- Gaziosmanpasa University Faculty of Medicine, Department of Physiology, Tokat, Turkey
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Abstract
Calcitonin is a hormone secreted by the C-cells of the thyroid gland in response to elevations of the plasma calcium level. It reduces bone resorption by inhibiting mature active osteoclasts and increases renal calcium excretion. It is used in the management of postmenopausal osteoporosis, Paget’s disease of bone, and malignancy-associated hypercalcemia. Synthetic and recombinant calcitonin preparations are available; both have similar pharmacokinetic and pharmacodynamic profiles. As calcitonin is a peptide, the traditional method of administration has been parenteral or intranasal. This hinders its clinical use: adherence with therapy is notoriously low, and withdrawal from clinical trials has been problematic. An oral formulation would be more attractive, practical, and convenient to patients. In addition to its effect on active osteoclasts and renal tubules, calcitonin has an analgesic action, possibly mediated through β-endorphins and the central modulation of pain perception. It also exerts a protective action on cartilage and may be useful in the management of osteoarthritis and possibly rheumatoid arthritis. Oral formulations of calcitonin have been developed using different techniques. The most studied involves drug-delivery carriers such as Eligen® 8-(N-2hydroxy-5-chloro-benzoyl)-amino-caprylic acid (5-CNAC) (Emisphere Technologies, Cedar Knolls, NJ). Several factors affect the bioavailability and efficacy of orally administered calcitonin, including amount of water used to take the tablet, time of day the tablet is taken, and proximity to intake of a meal. Preliminary results looked promising. Unfortunately, in two Phase III studies, oral calcitonin (0.8 mg with 200 mg 5-CNAC, once a day for postmenopausal osteoporosis and twice a day for osteoarthritis) failed to meet key end points, and in December 2011, Novartis Pharma AG announced that it would not pursue further clinical development of oral calcitonin for postmenopausal osteoporosis or osteoarthritis. A unique feature of calcitonin is that it is able to uncouple bone turnover, reducing bone resorption without affecting bone formation and therefore increasing bone mass and improving bone quality. This effect, however, may be dose-dependent, with higher doses inhibiting both resorption and formation. Because so many factors affect the pharmacokinetics and pharmacodynamics of calcitonin, especially orally administered calcitonin, much work remains to be done to explore the full pharmacologic spectrum and potential of calcitonin and determine the optimum dose and timing of administration, as well as water and food intake.
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Affiliation(s)
- Ronald C Hamdy
- Osteoporosis Center, College of Medicine, East Tennessee State University, Johnson City, TN, USA ; Veterans Affairs Medical Center, Johnson City, TN, USA
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Effects of calcitonin on knee osteoarthritis and quality of life. Rheumatol Int 2012; 33:423-7. [PMID: 22453526 DOI: 10.1007/s00296-012-2399-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 03/11/2012] [Indexed: 01/28/2023]
Abstract
There has been a recent interest in calcitonin as a potential treatment for osteoarthritis, based on its metabolic activities in both bone turnover and cartilage. The aim of this study was to evaluate the effects of nasal form calcitonin on knee osteoarthritis and quality of life in women who receive calcitonin treatment for postmenopausal osteoporosis. Two hundred and twenty postmenopausal women, aged between 55 and 65 years with knee pain and knee osteoarthritis, graded II-III by using Kellgren-Lawrence radiographic scoring system, were included. Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, the quality of life questionnaire of the European Foundation for Osteoporosis (QALEFFO-41) and visual analog scale were used for the algofunctional assessments. Need of rescue analgesic was recorded. Pain (P < 0.001), stiffness (P < 0.05), functional capability (P < 0.05) and total score of WOMAC (P < 0.05) revealed statistically significant improvements after 3 months of the treatment and remained consistent throughout 1 year of the treatment period. Participants experienced significant reductions in WOMAC perceptions of pain (-53 %), joint stiffness (-44 %) and limitations in physical function (-49 %) at the end of 1 year of calcitonin treatment. Need of rescue analgesic intake was reported to have decreased approximately by 60 % at the end of the 1-year treatment period. QUALEFFO_41 scores improved: 37.6 (baseline), 30.9 (3 months), 28.0 (6 months) and 24.4 (1 year). In conclusion, nasal calcitonin treatment provided dual action on osteoporosis and osteoarthritis with significant improvements in quality of life and algofunctional results in knee osteoarthritis.
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Knopp-Sihota JA, Newburn-Cook CV, Homik J, Cummings GG, Voaklander D. Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Osteoporos Int 2012; 23:17-38. [PMID: 21660557 DOI: 10.1007/s00198-011-1676-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 03/17/2011] [Indexed: 12/22/2022]
Abstract
Vertebral collapse is a common fracture associated with osteoporosis. Subsequent pain may be severe and often requires medications and bed rest. Several studies have suggested the use of calcitonin for the treatment of fracture pain. We sought to determine the analgesic efficacy of calcitonin for acute and chronic pain of osteoporotic vertebral compression fractures (OVCF). We searched for randomized, placebo, and controlled trials that evaluated the analgesic efficacy of calcitonin for pain attributable to OVCFs. We performed meta-analyses to calculate standardized mean differences (SMDs) using a fixed or random effects model. The combined results from 13 trials (n = 589) determined that calcitonin significantly reduced the severity of acute pain in recent OVCFs. Pain at rest was reduced by week 1 [mean difference (MD) = -3.39, 95% confidence interval (CI) = -4.02 to -2.76), with continued improvement through 4 weeks. At week 4, the difference in pain scores with mobility was even greater (SMD = -5.99, 95% CI = -6.78 to -5.19). For patients with chronic pain, there was no statistical difference between groups while at rest; there was a small, statistically significant difference between groups while mobile at 6 months (SMD = 0.49, 95% CI = -0.85 to -0.13, p = 0.008). Side effects were mild, with enteric disturbances and flushing reported most frequently. Although calcitonin has proven efficacy in the management of acute back pain associated with a recent OVCF, there is no convincing evidence to support the use of calcitonin for chronic pain associated with older fractures of the same origin.
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Affiliation(s)
- J A Knopp-Sihota
- Centre for Nursing and Health Studies, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, Canada.
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15
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Abstract
Mesotherapy involves the use of multiple intradermal or subcutaneous injections of a mixture of compounds in minute doses, by means of very fine needles, directly over/near the affected sites. Originally invented in France to manage painful medical conditions, it is presently the buzz word in the field of cosmetic dermatology, chiefly to get rid of disfiguring fat. Depending upon the condition treated, the drugs injected, the techniques followed and the number of sessions involved vary. The wider reception of mesotherapy by its stakeholders are probably due to factors like inexpensive equipments, relatively minimal training for providers, much reduced dosage need of the drugs with resultant minimal untoward effects, quicker realization of benefits, minimal invasiveness/pain involved and not the least it is an outpatient procedure. Despite so many plus points, it has to be noted that currently there is a dearth of rigorous scientific studies to prove its efficacy and safety. Further, the average cost per session alone ranges from 200 USD to 600 USD.
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Affiliation(s)
- G Sivagnanam
- Professor of Pharmacology, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
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16
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Bukata SV, Kates SL, O'Keefe RJ. Short-term and long-term orthopaedic issues in patients with fragility fractures. Clin Orthop Relat Res 2011; 469:2225-36. [PMID: 21279487 PMCID: PMC3126940 DOI: 10.1007/s11999-011-1779-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with impaired bone quality who suffer a fragility fracture face substantial challenges in both their short- and long-term care. In addition to poor bone quality, many of these patients have multiple medical comorbidities that alter their surgical risk and affect their ultimate functional recovery. Some medical issues can contribute to the altered bone quality and must be addressed to prevent future fractures. QUESTIONS/PURPOSES This review summarizes the modifications in perioperative management and fracture fixation in patients with common fragility fractures who have impaired bone quality. It also summarizes the postoperative diagnosis and treatment of secondary causes of impaired bone quality in these patients. METHODS We performed a PubMed search, and literature published after 2000 was prioritized, with the exception of benchmark clinical trial studies published before 2000. RESULTS Patients with altered bone quality require rapid perioperative management of multiple medical comorbidities. Implant selection in patients with poor quality bone should permit early weightbearing, and constructs should maximize surface area contact with the remaining bone. Long-term diagnosis and treatment of other disease states contributing to poor bone quality (vitamin D deficiency/insufficiency, hypothyroidism, hyperthyroidism, hyperparathyroidism, Cushing's disease, and hypogonadism) must occur to minimize the chances of future fractures. CONCLUSIONS Recognition of patients with impaired bone quality and proper treatment of their special needs in both the short and long term are essential for their best opportunity for maximal functional recovery and prevention of future fractures.
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Affiliation(s)
- Susan V Bukata
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14534, USA.
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17
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Humble SR. Calcitonin for Acute Neuropathic Pain Associated with Spinal Cord Injury. Anaesth Intensive Care 2011; 39:682-6. [DOI: 10.1177/0310057x1103900425] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuropathic pain associated with spinal cord injury is caused by complex neural mechanisms and is often refractory to standard therapy. Salmon calcitonin was an effective treatment for neuropathic symptoms in this case series of three patients with recent spinal cord injury. Salmon calcitonin is already used to help manage pain after limb amputation and also after vertebral fractures and it is perhaps surprising that it has not been trialled previously for spinal cord injury pain. Calcitonin is thought to exert its effect by modulation of the serotonergic system and is generally well tolerated and convenient to administer. This underutilised drug may be a very useful adjuvant for neuropathic pain associated with spinal cord injury.
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Affiliation(s)
- S. R. Humble
- Department of Anaesthesia, Pain Management Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
- Wellcome Trust Research Fellow, Neurosciences Institute, University of Dundee and Specialist Registrar in Anaesthesia and Pain Medicine, Ninewells Hospital and Medical School
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19
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Lyritis G, Marin F, Barker C, Pfeifer M, Farrerons J, Brixen K, del Pino J, Keen R, Nickelsen TN. Back pain during different sequential treatment regimens of teriparatide: results from EUROFORS. Curr Med Res Opin 2010; 26:1799-807. [PMID: 20482322 DOI: 10.1185/03007995.2010.488516] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate changes in back pain in postmenopausal women with severe osteoporosis who received teriparatide for 24 months or switched at 12 months to raloxifene or no active treatment. STUDY DESIGN AND METHODS This prospective, controlled, randomised, open-label, 2-year study enrolled 868 postmenopausal women with osteoporosis and a recent fragility fracture. After 12 months of teriparatide (20 microg/day), 507 patients were randomised to further teriparatide (n = 305), raloxifene 60 mg/day (n = 100), or no active treatment (n = 102) for another 12 months (substudy 1); in substudy 2, 199 patients continued teriparatide. All received calcium and vitamin D supplementation. Back pain was self-assessed by patients using a visual analogue scale (0-100 mm). Changes in back pain were analysed using a mixed model for repeated measures. RESULTS During year 1, back pain decreased from a mean (SD) of 48.9 mm (24.0) at baseline by 11.5 mm (p < 0.001) in the total study population. In substudy 1, mean change in back pain from month 12 (randomisation) to 24 months was -2.2, -4.4 and +0.7 mm in the teriparatide (p = 0.076), raloxifene (p = 0.041), and no active treatment groups (p = 0.751). There were no between-group differences from randomization to 18 or 24 months. In a sensitivity analysis excluding patients with low baseline back pain (VAS < 30 mm), mean change from randomisation to endpoint was significant for teriparatide (-3.9 mm, p = 0.006) and raloxifene (-6.3 mm, p = 0.018) groups. Subgroup analyses of 503 patients who received teriparatide for up to 2 years showed that patients with a recent vertebral fracture had a greater decrease in back pain than those without (p < 0.05). Those with and without mild back pain (>or=30 mm), and those with and without severe back pain (>or=60 mm) at baseline all had a statistically significant reduction in back pain after 24 months (p < 0.05). CONCLUSIONS Teriparatide treatment is associated with significant reductions in back pain regardless of the presence of recent vertebral fracture. These results need to be considered with caution due to the open-label design of the study.
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20
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Abstract
Osteoporotic vertebral fractures are associated with considerable reduction of quality of life, morbidity, and mortality. The management of patients with vertebral fractures should include treatment for osteoporosis and measures to reduce pain and improve mobility. This article provides information for management and rehabilitation of vertebral fractures based on clinical experience and literature.
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21
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Abstract
Mesotherapy involves the use of multiple intradermal or subcutaneous injections of a mixture of compounds in minute doses, by means of very fine needles, directly over/near the affected sites. Originally invented in France to manage painful medical conditions, it is presently the buzz word in the field of cosmetic dermatology, chiefly to get rid of disfiguring fat. Depending upon the condition treated, the drugs injected, the techniques followed and the number of sessions involved vary. The wider reception of mesotherapy by its stakeholders are probably due to factors like inexpensive equipments, relatively minimal training for providers, much reduced dosage need of the drugs with resultant minimal untoward effects, quicker realization of benefits, minimal invasiveness/pain involved and not the least it is an outpatient procedure. Despite so many plus points, it has to be noted that currently there is a dearth of rigorous scientific studies to prove its efficacy and safety. Further, the average cost per session alone ranges from 200 USD to 600 USD.
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Affiliation(s)
- G Sivagnanam
- Professor of Pharmacology, Indira Gandhi Medical College and Research Institute, Kadirkamam, Puducherry, India
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22
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Katae Y, Tanaka S, Sakai A, Nagashima M, Hirasawa H, Nakamura T. Elcatonin injections suppress systemic bone resorption without affecting cortical bone regeneration after drill-hole injuries in mice. J Orthop Res 2009; 27:1652-8. [PMID: 19489046 DOI: 10.1002/jor.20920] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It is assumed that there are systemic changes in mineral metabolism during fracture healing that may cause a predisposition to sequential fractures in osteoporotic patients who suffered from previous fractures. Initial therapies for patients with osteoporotic fractures are important to prevent disabilities in daily life consequent to bone and muscle atrophies, and sequential fractures, although systemic and local bone metabolism during fracture healing have not been well understood. We evaluated the effects of bone injury and elcatonin injection as an initial therapy on systemic and local bone turnover and bone wound healing. Two drill holes were made in the diaphysis of the left femur and tibia of 12-week-old male C57BL/6J mice. They were treated with three doses of elcatonin or a vehicle thrice a week until the end of the 28-day experiment. Urinary crosslinked C-telopeptide of type I collagen (CTX) increased and the bone mineral densities (BMDs) in the lumbar vertebrae decreased in the vehicle-treated mice. Elcatonin injection prevented increases in urinary CTX and reduction of the BMDs. In the noninjured femoral metaphysis, osteoclast surface increased until day 28, whereas elcatonin suppressed it. In the fracture site, elcatonin facilitated osteoblast proliferation and did not delay the healing of the bone defect. Bone injuries accelerated bone turnover systemically and locally, and the elcatonin injections suppressed the systemic acceleration of bone resorption without a delay of filling regenerated cortical bone in the bone defect.
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Affiliation(s)
- Yuji Katae
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, 807-8555, Japan
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23
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Simić P, Giljević Z, Simunić V, Vukicević S, Korsić M. Treatment of Osteoporosis. Arh Hig Rada Toksikol 2007; 58:55-71. [PMID: 17424786 DOI: 10.2478/v10004-007-0009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Liječenje OsteoporozeOsteoporoza je jedna od najčešćih metaboličkih bolesti i zahvaća 8 % do 10 % stanovništva. Budući da je prijelom najteža posljedica osteoporoze, vrlo je važno otkriti bolesnike koji imaju rizik nastanka prijeloma, dati im farmakološku terapiju i savjetovati im promjenu načina života. Nekoliko je lijekova pokazalo sposobnost smanjenja broja prijeloma kralježnice i/ili perifernog skeleta u bolesnika s osteoporozom. Antiresorptivni su lijekovi temelj terapije, ali su i anabolički lijekovi odnedavno proširili mogućnosti liječenja. Antiresorptivni lijekovi, estrogeni, selektivni modulatori estrogenskih receptora, bisfosfonati i kalcitonin, djeluju tako da smanjuju koštanu pregradnju. Paratireoidni hormon potiče novo stvaranje kosti popravljajući arhitekturu i gustoću kosti. Stroncijev ranelat smanjuje rizik osteoporotičnih prijeloma djelujući na oboje - smanjenje razgradnje i povećanje izgradnje kosti. Druga potencijalna liječenja osteoporoze također su opisana u ovome članku.
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Affiliation(s)
- Petra Simić
- Medicinski fakultet Sveucilista u Zagrebu, Klinika za internu medicinu Klinickog bolnickog centra Zagreb, Hrvatska
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24
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Abstract
Cancer pain assessment and management are integral to palliative medicine. This paper reviews recent publications in the period 1999-2004 in the broad categories of epidemiology, pain assessment, nonpharmacologic approaches to cancer pain (radiation therapy, anesthetic blocks, palliative surgery and chemotherapy, complementary and alternative medicine), and in nociceptive pain, neuropathic pain, visceral pain, and bone pain.
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Affiliation(s)
- Victor T Chang
- VA New Jersey Health Care System, PDIA Faculty Scholar, East Orange, New Jersey 07018, USA.
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25
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Shindle MK, Shindle L, Gardner MJ, Lane JM. Supportive Care Aspects of Vertebroplasty and Kyphoplasty in Patients with Cancer. ACTA ACUST UNITED AC 2006; 3:214-9. [DOI: 10.3816/sct.2006.n.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Karsdal MA, Tanko LB, Riis BJ, Sondergard BC, Henriksen K, Altman RD, Qvist P, Christiansen C. Calcitonin is involved in cartilage homeostasis: is calcitonin a treatment for OA? Osteoarthritis Cartilage 2006; 14:617-24. [PMID: 16698291 DOI: 10.1016/j.joca.2006.03.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 03/28/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is the most common form of degenerative joint diseases and a major cause of disability and impaired quality of life in the elderly. Recent observations suggest that calcitonin may act on both osteoclasts and chondrocytes. The present review was sought to summarize emerging observations from the molecular level to the preliminary clinical findings of possible chondroprotective effects of calcitonin. METHOD This review summarizes peer-reviewed articles found using pre-defined search criteria and published in the PubMed database before January 2006. In addition, abstracts from the OsteoArthritis Research Society International (OARSI) conferences in the time period 2000-2005 have been included in the search. RESULTS Ample evidence for the effect of calcitonin on bone resorption was found. Support for direct effects of calcitonin on chondrocytes on matrix synthesis and inhibition of cartilage degradation have been published. In addition, clinical evidence for the effect of calcitonin on cartilage degradation is emerging. CONCLUSION Several independent lines of evidence suggest a direct chondroprotective effect of calcitonin in addition to the well-established effect on bone resorption. Given the currently limited availability of chondroprotective agents, much expectation regards the ongoing clinical assessment of calcitonin therapy for the prevention and treatment of OA.
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Affiliation(s)
- M A Karsdal
- Nordic Bioscience Diagnostics, Herlev, Denmark.
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27
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Knopp JA, Diner BM, Blitz M, Lyritis GP, Rowe BH. Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: a systematic review of randomized, controlled trials. Osteoporos Int 2005; 16:1281-90. [PMID: 15614441 DOI: 10.1007/s00198-004-1798-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 10/18/2004] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Jennifer A Knopp
- Family Medicine SF1, 22 WMC, University of Alberta Hospital, Edmonton, Alberta T6G 2B7, Canada
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28
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Sahin F, Yilmaz F, Kotevoglu N, Kuran B. Efficacy of salmon calcitonin in complex regional pain syndrome (type 1) in addition to physical therapy. Clin Rheumatol 2005; 25:143-8. [PMID: 15980934 DOI: 10.1007/s10067-005-1153-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Revised: 03/11/2005] [Accepted: 03/11/2005] [Indexed: 11/26/2022]
Abstract
The aim of the study was to assess the efficacy of salmon calcitonin, which was suggested as effective in the treatment of complex regional pain syndrome type 1 (CRPS 1). Patients who had suffered trauma to their upper extremities and developed CRPS 1 were included into this randomised, controlled single-blind study. The diagnosis was made according to the clinical examination and scintigraphy. The evaluation parameters were: pain [visual analogue scale (VAS)], the angle of dorsiflexion (DF) and palmar flexion (PF) of the wrist, distance between the fingertip and distal palmar crease (FT-DPC), allodynia, hyperalgesia and trophic changes. One group received paracetamol 1500 m/day and the other group salmon calcitonin 200 IU/day for 2 months. All of the patients participated in a physical therapy and exercise programme. A total of 35 patients were divided into two groups, who were found to be similar for age, body mass index, period of trauma, period of rest in a plaster splint or bandage, the duration of symptoms, VAS, DF and PF angle, FT-DPC, presence of allodynia, hyperalgesia and trophic changes (p>0.05). The control examination showed similar results for allodynia, hyperalgesia and trophic changes, whereas remarkable improvement was observed in the rest of the parameters within groups. On the other hand, between the two groups there was no significant difference in any of the parameters (p>0.05) This randomised, single-blind study showed that all of the patients with acute CRPS 1 in their upper extremities after trauma, who were treated with either paracetamol or calcitonin along with physical therapy, recovered in all parameters significantly, but without any difference between groups. We can conclude that calcitonin does not make any favourable contribution in the treatment of patients with acute CRPS 1; physical therapy combined with only a simple analgesic is an efficient means of therapy.
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Affiliation(s)
- Fusun Sahin
- Department of Physical Medicine and Rehabilitation, Sisli Etfal Education and Research Hospital, Istanbul, Turkey.
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29
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Abstract
Trauma is a major cause of mortality throughout the world. In recent years, major advances have been made in the management of trauma, the end result of which has been reduced mortality and enhanced function. One of these areas is pain control. Improved pain management has not only led to increased comfort in trauma patients, but has also been shown to reduce morbidity and improve long-term outcomes. This review focuses on the treatment of pain in the setting of acute injury and on pain management in trauma patients who go on to develop chronic pain. Emphasis is placed on pharmacologic interventions, invasive and noninvasive pain management techniques, analgesia in challenging patients, and pain control in commonly encountered trauma conditions.
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Affiliation(s)
- Steven P Cohen
- Pain Management Center, Department of Anesthesiology, New York University School of Medicine, New York, NY, USA
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30
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Abstract
Post-menopausal osteoporosis is characterized by increased fracture risk due to deficiencies in both the quantity and quality of bone. Assessing fracture risk involves combining clinical risk factors, including fall risks, with bone density testing. Treatment strategies are aimed at reducing fracture risk. General nutritional and lifestyle measures are appropriate for all women. Drug treatment is most clearly indicated in post-menopausal women at high current fracture risk. Treatment should also be considered for women at intermediate fracture risk, including those who have both low bone density and other risk factors for fracture. Whether there is practical clinical value in treating low-risk patients is much less clear. Non-pharmacological approaches addressing the consequences of fractures are integral parts of a comprehensive treatment programme. Reducing both the frequency and the effects of falls complements the efforts of treating osteoporosis to reduce the incidence of fractures and their important clinical consequences.
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Affiliation(s)
- Michael R McClung
- Oregon Osteoporosis Center, 5050 NE Hoyt Street, Suite 651, Portland, OR 97210, USA.
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