Martinez-Zapata, M.J., Roque, M., Alonso-Coello, P., & Catala, E. (2006). Calcitonin for metastatic bone pain. Cochrane Database of Systematic Reviews, 3, CD003223.

Databases searched were MEDLINE (1966–2005), EMBASE (1974–2005), Cochrane Central Register of Controlled Trials (issue 2, 2005), and specialized registers of the Cochrane Cancer Network and the Cochrane Pain, Palliative and Supportive Care Group. Also searched were metaRegister of Controlled Trials, U.S. National Institutes of Health register, register of the Center for Clinical Trials and Evidence-Based Healthcare, and register of the European Organization for Research and Treatment of Cancer.

Registers of trials in progress also were assessed.

Studies were included in the review if they

• Reported on calcitonin plus a rescue medication versus placebo plus a rescue medication
• Used any comparison between different models and intervention doses of interest
• Included use of steroids or analgesic radiotherapy if administration was equal in each treatment arm.

Studies where bisphosphonates were administered before patients were randomized to different treatment arms and studies where the efficacy of calcitonin in treating pain was measured over a short period (less than four weeks) were excluded.

The review included two randomized, double-blind clinical trials of patients with metastatic bone pain for a total of 90 patients. The first study compared calcitonin (100 IU administered subcutaneously each day for 28 days) versus placebo administered to a group of 40 women with breast cancer and pain from bone metastasis. The second study compared calcitonin (100 IU administered subcutaneously each day for three months) versus placebo in 50 women with breast cancer and painful bone metastases.

Of the two studies selected (90 patients), all patients had metastatic bone pain caused by any primary tumor, diagnosed by computed tomography, bone gammagraphy, nuclear magnetic resonance, or other radiographic process.

The limited available evidence does not support the use of calcitonin to control pain from bone metastases.

Calcitonin has been assessed in studies with small sample sizes and too short-term evaluations.

More double-blind, parallel clinical trials using long-term evaluations are needed.