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elief between pamidronate and calcitonin. 11 Given the relative strengths of
evidence for calcitonin and the bisphosphonates, and the drugs’ safety and
side effect profiles, we recommend reserving pamidronate for situations
where other approaches fail or are contraindicated.
n Summary and recommendations
First line:
n acetaminophen (650–1000 mg PO QID) for mild–moderate pain
n opioids (e.g. oxycodone 2.5–5mgPOq4–6h) for 2–3 days until calcitonin
takes effect
n calcitonin (200IU salmon-derived preparation IN QD)
Reasonable: NSAIDs (e.g. ibuprofen 600–800 mg PO q6–8h, maximum daily
2400 mg) if favorable risk profile
Special cases:
n patient allergic to fish: use synthetic calcitonin (200 IU IN QD)
n intolerability or failure of other approaches: pamidronate (in consultation
with follow-up physicians)
References
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3. Kanis JA, McCloskey EV. Effect of calcitonin on vertebral and other fractures. Q
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5. Lyritis G, Ioannidis G, Karachalios T, et al. Analgesic effect of salmon calcitonin
suppositories in patients with acute pain due to recent osteoporotic vertebral
crush fractures: a prospective, double-blind, randomized, placebo-controlled
clinical study. Clin J Pain. 1999;15(4):284–289.