Calcitonin used to treat metastatic bone pain

The limited evidence currently available does not support the use of calcitonin to control pain arising from bone metastases. People who have cancer which has spread to their bones and the nerves adjacent to the bones often suffer severe pain. There are several treatments to help relieve this pain: radiotherapy, analgesic (pain-relieving) drugs such as opioids and bone-modulating drugs such as bisphosphonates and calcitonin. Calcitonin has the potential to relieve pain and maintain bone strength, thus reducing the risk of bone fractures. This review looked at the effectiveness of calcitonin for controlling pain from bone metastases. However, few studies were found and the evidence currently available does not support its use for patients suffering from bone pain. Until new studies provide additional information on this treatment, other therapeutic approaches should be considered.

Authors' conclusions: 

The limited evidence currently available does not support the use of calcitonin to control pain from bone metastases. Since the last version of this review, none of the new relevant studies have provided additional information on this treatment, in contrast to other therapeutic approaches that should be considered.

Read the full abstract...
Background: 

Pain is the most frequent symptom experienced by cancer patients, its intensity dependent on the site of the tumour. Tumours that compromise bone or nervous structures due to the bone destruction process are the most painful. There are several treatments to deal with pain (and other symptoms) caused by bone metastases. The hormone calcitonin has the potential to relieve pain and also retain bone density, thus reducing the risk of fractures. This review is an update of a previously published review in The Cochrane Library (2003, Issue 3) which was also updated in 2006 (Issue 3).

Objectives: 

To assess the effectiveness of calcitonin in controlling metastatic bone pain and reducing bone complications (hypercalcemia, fractures and nerve compression) in patients with bone metastases.

Search strategy: 

We updated the electronic searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE up to October 2011. We also searched registers of clinical trials in progress.

Selection criteria: 

We included studies if they were randomised, double-blind clinical trials of patients with metastatic bone pain, treated with calcitonin, where the major outcome measure was pain, assessed at four weeks or longer.

Data collection and analysis: 

Two independent review authors performed study selection and data extraction. Only two studies (90 participants) were eligible for inclusion in the review and therefore meta-analysis of the data was not possible. We performed intention-to-treat (ITT) analysis by imputing all missing values as adverse outcomes.

Main results: 

Of the two small included studies, one study showed a non-significant effect of calcitonin on the number of patients with total pain reduction (risk ratio (RR) 2.50; 95% confidence interval (CI) 0.55 to 11.41). The second study provided no evidence that calcitonin reduced analgesia consumption (RR 1.05; 95% CI 0.90 to 1.21) in patients with painful bone metastases. There was no evidence that calcitonin was effective in controlling complications due to bone metastases, for improving quality of life or for patients' survival. Although not statistically significant, a greater number of adverse effects were observed in the groups given calcitonin in the two included studies (RR 3.35; 95% CI 0.72 to 15.66).