Siminoski K, Josse R G
Department of Medicine, University of Alberta, Edmonton.
CMAJ. 1996 Oct 1;155(7):962-5.
To describe potential therapeutic uses of calcitonin in the prevention and treatment of osteoporosis.
Parenterally and intranasally administered calcitonin (eel, salmon or human).
Fracture, fracture pain and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures, reduction of pain and improved quality of life associated with calcitonin treatment.
Relevant clinical studies and reports were examined, with an emphasis on recent randomized, placebo-controlled trials. In vitro and in vivo studies of osteoclast activity were also considered.
Reducing fractures and fracture pain, increasing bone mineral density and minimizing side effects of treatment were given a high value.
BENEFITS, HARMS AND COSTS: Calcitonin reduces acute pain associated with osteoporotic fractures and has been found useful in treating chronic back pain following vertebral fractures in spinal osteoporosis. It can prevent bone loss and may be effective in preventing fractures. Side effects are dose related and generally mild; they include gastrointestinal, vascular and dermatologic conditions that can be treated symptomatically or by varying the dosage. Side effects are much rarer with nasal administration than with injection. True allergic reactions are rare.
Calcitonin in both intramuscular and intranasal forms can reduce the pain of acute osteoporotic vertebral fractures and may be effective in treating that associated with chronic vertebral osteoporotic fractures. Calcitonin may also prevent postmenopausal bone loss and increase bone density in those with established osteoporosis. Current evidence for long-term prevention of fractures is limited and does not support the use of calcitonin as a first-line treatment for established osteoporosis. Most side effects can be avoided with nasal administration. Further trials are needed to assess fracture prevention and effective dose ranges for treating pain and increasing bone mineral density and to determine the long-term efficacy of calcitonin in secondary osteoporosis, in premenopausal women, in men and in elderly people.
描述降钙素在预防和治疗骨质疏松症方面的潜在治疗用途。
经肠胃外和鼻内给药的降钙素（鳗鱼、鲑鱼或人源）。
骨质疏松症中的骨折、骨折疼痛和骨矿物质密度降低；降钙素治疗带来的骨量增加、骨折预防、疼痛减轻及生活质量改善。
审查了相关临床研究和报告，重点是近期的随机、安慰剂对照试验。还考虑了破骨细胞活性的体外和体内研究。
减少骨折和骨折疼痛、增加骨矿物质密度并将治疗副作用降至最低被高度重视。
益处、危害和成本：降钙素可减轻与骨质疏松性骨折相关的急性疼痛，已发现其对治疗脊柱骨质疏松症椎体骨折后的慢性背痛有用。它可以预防骨质流失，可能对预防骨折有效。副作用与剂量相关，一般较轻；包括胃肠道、血管和皮肤方面的状况，可对症治疗或通过改变剂量来处理。鼻内给药的副作用比注射少见得多。真正的过敏反应罕见。
肌肉注射和鼻内给药的降钙素均可减轻急性骨质疏松性椎体骨折的疼痛，可能对治疗与慢性椎体骨质疏松性骨折相关的疼痛有效。降钙素还可能预防绝经后骨质流失，并增加已患骨质疏松症患者的骨密度。目前关于长期预防骨折的证据有限，不支持将降钙素用作已患骨质疏松症的一线治疗药物。鼻内给药可避免大多数副作用。需要进一步试验来评估骨折预防以及治疗疼痛和增加骨矿物质密度的有效剂量范围，并确定降钙素在继发性骨质疏松症、绝经前女性、男性和老年人中的长期疗效。
