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Effect of elcatonin versus nonsteroidal anti-inflammatory medications for acute back pain in patients with osteoporotic vertebral fracture: a multiclinic randomized controlled trial

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Abstract

The aim of this study was to compare the efficacy of elcatonin injections and oral nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with osteoporosis who have acute lumbar pain after experiencing new vertebral compression fractures. Two hundred twenty-eight Japanese female patients (mean age 77.3 years) with acute lumbar pain from osteoporotic vertebral fractures were randomly divided into two groups. Patients in one group were given an NSAID (NSAIDs group) and patients in the other group were given weekly intramuscular injections of 20 units of elcatonin (elcatonin group). All patients underwent follow-up examinations up to 6 weeks from the start of the trial. Outcome measures were the level of functional impairment according to the Japan Questionnaire for Osteoporotic Pain (JQ22), the Roland–Morris Disability Questionnaire (RDQ), and a visual analog scale (VAS) of pain intensity. Statistical analyses focused on (1) the time course of pain and functional level using linear mixed effects models to analyze the longitudinal data and (2) the effectiveness of elcatonin injection with mean difference values and 95 % confidence intervals. Significant differences were seen over time between the initial values and the postintervention values (4 and 6 weeks) in JQ22, RDQ, and VAS scores (effect size d > 0.4) in each group. The mean differences between the elcatonin group and the NSAIDs group in each measure at 4 and 6 weeks were −4.8 and −8.3 for the JQ22, −1.3 and −2.6 for the RDQ, and −11.3 and −11.5 for the VAS, shifted to elcatonin. Once weekly elcatonin injection was more effective than NSAIDs for treating acute lumbar pain and improving mobility in Japanese women with osteoporotic vertebral fractures.

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Acknowledgments

We thank all the orthopedic surgeons, their staff, and their patients who willingly participated in this study. The participation of the following hospitals and clinics is also greatly appreciated: Ishigaki Orthopaedic Clinic, Kaji Orthopaedic Clinic, Kanjo-dori Higashi Orthopaedics, Miyamoto Orthopaedics, Miyanosawa Orthopaedic Clinic, Okuizumi Orthopaedics, Sapporo Hospital, Sapporo Kiyota Orthopaedic Hospital, Sapporo Maruyama Orthopaedic Hospital, Sapporo Orthopaedics, Shinoda Orthopaedics, Toshima Orthopaedic Clinic, Yamanote-dori Yagi Hospital, Hakodate Central General Hospital, Yoshida Orthopaedics, Namiki Orthopaedic Clinic, Sasaki Orthopaedic and Anesthetic Clinic, Shiobara Spa Hospital, Hirano Orthopaedic Clinic, Fujino Orthopaedic Clinic, Kakegawa Municipal General Hospital, Kaname Orthopaedics, Kato Orthopaedic Clinic, Okada Orthopaedics, Saito Orthopaedic Clinic, Seirei Hamamatsu General Hospital, Shiramatsu Orthopaedics, Izu-Nirayama Spa Hospital, Kamoto Orthopaedic Clinic, Matsuura Orthopaedics, Miyake Orthopaedic Clinic, Ohya Orthopaedic Clinic, Sugiyama Orthopaedic and Rehabilitation Clinic, Tanebe Orthopaedic Clinic, Togawa Orthopaedics, Morita Orthopaedic Clinic, Murai Orthopaedic Clinic, Nakamura Orthopaedic Clinic, Niigata Rinko Hospital, Ohura Orthopaedic Clinic, Watanabe Orthopaedics, Iwai Orthopaedic Clinic, Takada Orthopaedic Clinic, Takaoka-Seisikai Hospital, Wago Orthopaedic Clinic, Kamata Orthopaedic Clinic, Maki Orthopaedic Clinic, Suzu Orthopaedics, Kishimoto Orthopaedics, Maenaka Orthopaedic Clinic, Takada Iin (Orthopaedics and Internal Medicine), Ukon Orthopaedic Clinic, Yamamoto Orthopaedics, Kira Orthopaedic Clinic, Ryuso Orthopaedic Hospital, Sakata Orthopaedic Clinic, Tamura Orthopaedics, Hiramatsu Orthopaedic Hospital, Hrada Rehabilitation and Orthopaedic Clinic, Okuda Orthopaedics and Dermatology Clinic, Shintani Orthopaedic Clinic, Nezu Orthopaedic Clinic, Takita Orthopaedic Clinic, Yamagata Orthopaedic Clinic, Aibara Orthopaedics, Hirose Orthopaedic and Rehabilitation Clinic, Masuda Orthopaedics, Nishimoto Orthopaedics, Seike Orthopaedics, Tanaka Clinic, Shinseikai Hospital, Okazaki Orthopaedic Clinic, Sakaue Orthopaedics, Tomonaga Orthopaedic Clinic, Kataoka Orthopaedic Clinic, Naruo Orthopaedic Hospital, Nishi Orthopaedic Clinic, Hashiguchi Orthopaedics, Kuwabata Orthopaedic Clinic, Niimura Orthopedics, Nakasone Orthopaedics, Nobinobi Orthopaedics, Takeuchi Orthopaedics, and Uezato Orthopaedics.

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Authors and Affiliations

  1. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Naoto Endo

  2. Fujino Orthopaedic Clinic, Fujino, Japan

    Keiji Fujino

  3. Fukuoka Clinic, Fukuoka, Japan

    Tokuhide Doi

  4. National Rehabilitation Center for Persons with Disabilities, Tokyo, Japan

    Masami Akai & Tsutomu Iwaya

  5. Department of Orthopaedic Surgery, Jichi Medical School, Shimotsuke, Japan

    Yuichi Hoshino

  6. Tamana Central Hospital, Tamana, Japan

    Tetsuo Nakano

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  1. Naoto Endo
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  2. Keiji Fujino
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  3. Tokuhide Doi
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  4. Masami Akai
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  5. Yuichi Hoshino
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  6. Tetsuo Nakano
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  7. Tsutomu Iwaya
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Correspondence to Naoto Endo.

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Conflict of interest

Naoto Endo, Keiji Fujino, Tokuhide Doi, Masami Akai, Yuichi Hoshino, Tetsuo Nakano, and Tsutomu Iwaya declare that they have no conflict of interest.

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On behalf of The Japanese Society for Musculoskeletal Medicine and the Japanese Clinical Orthopaedic Association.

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Endo, N., Fujino, K., Doi, T. et al. Effect of elcatonin versus nonsteroidal anti-inflammatory medications for acute back pain in patients with osteoporotic vertebral fracture: a multiclinic randomized controlled trial. J Bone Miner Metab 35, 375–384 (2017). https://doi.org/10.1007/s00774-016-0765-8

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  • DOI: https://doi.org/10.1007/s00774-016-0765-8

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