Authors' objectives:

To assess the state of knowledge regarding the efficacy, effectiveness and economic burden of intranasal calcitonin in the treatment of idiopathic osteoporosis.

Authors' results and conclusions: Intranasal calcitonin has shown a short term efficacy preserving and/or increasing bone mass in postmenopausal osteoporosis, especially in those women with increased rates of bone turnover. The bone mass increase is prominent in trabecular bone and its rates change among studies. However, there is no evidence about the long-term stability of that effect. Whether intranasal calcitonin indeed prevents fractures in elderly women is still unproven. However, one case control study shows that calcitonin significantly decreases the risk of hip fracture. Calcitonin has an analgesic effect on the skeleton. Nevertheless, there are not studies supporting its clinical prescription for this purpose. Calcitonin is a safe drug when used in the usual dosages. Short and long-term side effects are usually mild and transient and generally do no lead to organ toxicity. The cost of calcitonin is high. In Catalonia its prescription has steadily increased during the last years resulting in a considerable cost for the health care system. The balance between the high cost of calcitonin versus its therapeutic value has not been shown through published studies. There are not studies comparing the cost-effectiveness of this type of calcitonin in the treatment of idiopathic osteoporosis with the other therapeutic alternatives proposed in the published literature, as well as with prevention strategies.

Authors' recommendations: There is no evidence of clinical effectiveness to recommend for or against calcitonin in order to prevent osteoporotic fractures in the elderly. Although there are specific clinical situations in which calcitonin could be given, in view of its high cost and the poor quality of the evidence analyzed, the Catalan Agency for Health Technology Assessment states that, currently, unselective prescription for osteoporosis cannot be recommended. According to the US Preventive Task Force coding system, this represents a "C" recommendation.

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 1995

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research