Back pain due to vertebral collapse is the main symptom of postmenopausal osteoporosis. The clinical picture in these crush fractures varies, depending on the type and the location of fracture, but in general, a new vertebral crush fracture gives rise to severe pain that immobilizes the patient and necessitates bedrest. In this double-blind controlled clinical trial, 56 patients who had recently (within the last 3 days) suffered an osteoporotic vertebral fracture were hospitalized for a period of 14 days. Salmon calcitonin (100 IU) or placebo injections were given daily. Pain was rated daily on a 10-point scale by the same observers. Blood and urinary parameters were also evaluated. The results showed a significant (P less than 0.001) difference in pain intensity between the calcitonin group and the placebo group. This beneficial effect was generally apparent from the second day of treatment onward, and over the following 2 weeks, the patients were able to sit and stand, and gradually started to walk again. A significant decrease in urinary hydroxyproline and urinary calcium was also noted in the calcitonin group. It is concluded that calcitonin exerts a beneficial effect on back pain following a vertebral crush fracture.
The clinical picture of the osteoporotic fractures of the spine presents an heterogeneity in their intensity and duration. In 210 cases of osteoporotics with acute pain and radiological evidence of spinal fracture we separate their clinical picture in two groups. In Type I (121 cases) pain is acute and severe, improving gradually; the vertebral wedging is obvious from the beginning and remain unchanged. The duration of this event exceeds 4-8 weeks. In Type II (89 cases) pain is less and of shorter duration, but after 6-16 weeks a new attack of acute pain presents. This picture can be repeated for 6-18 months. Radiologically the fracture is not clear during the first attack but wedging gradually developed during the next months. Bone density of the lumbar spine (DPA) was measured in all cases. Type I had a significantly lower BMC than Type II. We suggest that patients with unclear vertebral fractures, minor symptoms and relatively high bone mass must classified in Group II and deterioration can occur during the next months. Long term treatment and additional orthopaedic prevention is needed. In Group I a short term calcitonin treatment helps early relief and mobilization.
To develop an improved treatment schedule for osteoporosis, a study was undertaken in 100 postmenopausal women using a modified ADFR 90-day cyclical regimen with etidronate. After one year of treatment, the etidronate-treated group showed a significant increase in bone density of the spine, which continued over the following 2 years of treatment and remained stable during the fourth year. In contrast, in the non-etidronate group, bone density decreased significantly after four years. In addition, the fracture rate was significantly lower in the etidronate group than in the non-etidronate group. Side effects were minimal in both groups and no serious adverse reactions were reported. In conclusion, it appears that a cyclical regimen using 1,25-dihydroxyvitamin D3, etidronate and calcium increases bone mass and reduces fractures with no significant side effects, thus making a useful contribution in the treatment of postmenopausal osteoporosis.
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