Intramuscularly administered elcatonin (ECT) reduces pain via the central nervous system. A prospective study was performed to determine whether ECT has a beneficial effect on back pain and function in postmenopausal women with osteoporosis during bisphosphonate therapy. Sixty-one postmenopausal osteoporotic women with back pain (mean age: 73.7 years, range: 54-96 years) were divided into two groups: the control group (n 30) and the ECT (intramuscular, 20 units a week) group (n 31). All patients received treatment with risedronate (17.5 mg weekly). The duration of the study was 8 weeks. Urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX), visual analogue scale (VAS) for back pain at rest and movement, and Roland-Morris Disability Questionnaire (RDQ) score for function were assessed. Urinary NTX levels, VAS at rest and movement, and RDQ score markedly decreased during 8 weeks of treatment in both ECT and control groups. A significant reduction in VAS at movement, but not in VAS at rest and RDQ score, was noted in the ECT group than in the control group. This effect was observed from 2 weeks after the start of therapy. These results suggested that ECT in combination with risedronate was more effective than risedronate alone for reducing back pain in postmenopausal women with osteoporosis.Key words elcatonin; risedronate; clinical vertebral fracture; postmenopausal woman; back pain Osteoporosis is commonly observed particularly in postmenopausal women, placing them at a significant risk of a fracture. Risedronate has been widely used as the first-line treatment for postmenopausal osteoporosis, because current evidence, based strictly on the principles of evidence-based medicine (EBM), suggests the efficacy of risedronate to reduce fracture incidence as well as its safety in postmenopausal women with osteoporosis.1-3) A recent systematic review analyzing 7 randomized controlled trials (RCTs) involving 14049 women confirms both clinically important and statistically significant reductions in vertebral, nonvertebral, and hip fractures after secondary prevention therapy. 4) It has been reported that the effect of risedronate to prevent clinical vertebral and nonvertebral fractures is recognized as early as 6 months after the start of treatment in postmenopausal women with osteoporosis.5,6) The anti-resorptive effects of nitrogen-containing bisphosphonates appear to result from their inhibition of an enzyme, farnesyl pyrophosphate synthase (FPPS), in osteoclasts.7) FPPS is a key enzyme in the mevalonate pathway, which generates isoprenoid lipids utilized for post-translational modification of small guanosine 5′-triphosphate (GTP)-binding proteins that are essential for osteoclast function. 7) One possible explanation for the early anti-fracture effect of risedronate is such inhibitory effect on FPPS in osteoclasts.Intramuscular treatment with elcatonin (ECT) is commonly used in Japan. ECT is a derivative of eel calcitonin synthesized by substituting an ethylene bond for its disulfide bond.8) ...