A Cochrane review [Abstract] 1 included 9 studies with a total of 441 subjects. Calcitonin was more effective than placebo at preserving bone mass at the lumbar spine after six and 12 months of therapy with a WMD of 2.8% (95% CI 1.4 to 4.3) and 3.2% (95% CI 0.3 to 6.1). At 24 months there was no statistically significant difference (WMD 4.5%, 95% CI -0.6 to 9.5). Bone density at the distal radius was also higher with calcitonin, but there was no difference at the femoral neck. The relative risk of vertebral fractures was 0.71 (95% CI 0.26 to 1.89) and the RR of non-vertebral fractures was 0.52 (95% CI 0.14 to 1.96). Withdrawals due to side effects were more common in the calcitonin group (RR 3.19, 95% CI 0.66 to 15.47). Important side effects included nausea and facial flushing.
Comment: The quality of evidence is downgraded by sparse data and study limitations. The authors conclude that therapies with proven fracture efficacy, such as bisphosphonates, should remain the first line treatment for patients at risk of steroid-induced osteoporosis, until further research becomes available.
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