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Review
. 2006 Jul 19;2006(3):CD003223.
doi: 10.1002/14651858.CD003223.pub2.

Calcitonin for metastatic bone pain

M J Martinez-Zapata  1 , M Roqué, P Alonso-Coello, E Català
Affiliations
Review

Calcitonin for metastatic bone pain

M J Martinez-Zapata et al. Cochrane Database Syst Rev. .

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 (Issue 3, 2003) on this topic.

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: Electronic searches were performed in MEDLINE (1966 to 2005), EMBASE (1974 to 2005), the Cochrane Central Register of Controlled Trials (Issue 2, 2005), specialised registers of the Cochrane Cancer Network and of the Cochrane Pain, Palliative and Supportive Care Group. Registers of clinical trials in progress were also searched.

Selection criteria: Studies were included 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: Study selection and data extraction were performed by two independent review authors. Only two studies (90 patients) were eligible for inclusion in the review and therefore meta-analysis of the data was not possible. Intention-to-treat analysis was performed by imputing all missing values as adverse outcomes.

Main results: Of the two small studies included in the review, one study showed a non-significant effect of calcitonin in the number of patients with total pain reduction (RR 2.50; CI 95%, 0.55 to 11.41). The second study provided no evidence that calcitonin reduced analgesia consumption (RR 1.05; CI 95%, 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 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, CI 95%, 0.72 to 15.66).

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.

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Conflict of interest statement

Dr. Martinez has no relevant conflicts of interest to declare.

Dr. Roqué has no relevant conflicts of interest to declare.

Dr. Roman has no relevant conflicts of interest to declare.

Dr. Català has no relevant conflicts of interest to declare.

Dr. Pablo Alonso‐Coello is funded by a Miguel Servet research contract from the Instituto de Salud Carlos III (CP09/00137).

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Calcitonin vs placebo (ITT: worst‐case scenario analysis), Outcome 1: Adverse effects
2.1
2.1. Analysis
Comparison 2: Calcitonin vs placebo (per protocol analysis), Outcome 1: Adverse effects
3.1
3.1. Analysis
Comparison 3: Calcitonin vs placebo (ITT: same as control scenario), Outcome 1: Adverse effects
See this image and copyright information in PMC

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References

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