We investigated the effect of calcitonin in the prevention of acute bone loss after a pertrochanteric fracture and its ability to reduce the incidence of further fractures in the same patient.

Fifty women aged between 70 and 80 years who had a pertrochanteric fracture of the hip were randomly allocated to group A (200 IU of nasal salmon calcitonin daily for three months) or group B (placebo).

Patients in group A showed a significantly higher level of total alkaline phosphatase and osteocalcin on the 15th day after injury and a significantly higher level of bone alkaline phosphatase on the 90th day after surgery. These patients also had significantly lower levels of urinary C-telopeptide (CrossLaps) on the 15th, 45th and 90th days after injury and lower levels of urinary hydroxyproline on the 15th and 45th days after injury. Patients in group A had significantly higher bone mineral density at all recorded sites except the greater trochanter at three months and one year after operation. After a four-year period of clinical observation, five patients (24%) in group B sustained a new fracture, in four of whom (20%) it was of the contralateral hip.

Our findings show that calcitonin reduces acute bone loss in patients with pertrochanteric fractures and may prevent the occurrence of new fractures of the contralateral hip in the elderly.

Purpose: The efficacy of nasal salmon calcitonin (CT) in preventing bone loss after a hip fracture and in reducing the incidence of further contralateral hip fractures was evaluated.

Material and Methods: Fifty women aged 70–80 years who sustained a pertrochanteric fracture were randomly allocated to Group A (200 IU of nasal salmon calcitonin daily for three months) and Group B (placebo). Biochemical bone markers (1st, 7th, 15th, 45th and 90th day post injury) and bone mineral density of the lumbar spine and the intact contralateral hip (4th and 90th postoperative day, and one year after the fracture) were measured.

Results: Patients in the calcitonin group showed statistically significantly higher total (p< 0,005) and bone alkaline phosphatase (p< 0,002) and osteocalcin (p< 0, 05) levels on the 15th day, while statistically significantly lower uCTX values on the 15th (p< 0,045), 45th (p< 0,002) and 90th (p< 0,002) day and uHpr/Cr values on the 15th (p< 0,015) and on the 45th (p< 0.05) day post injury. In the placebo group patients showed a statistically significant reduction (all p values < 0.05) of bone density values at 3 months and one-year post surgery while in the calcitonin group no significant changes from baseline. When the two groups were compared, patients in the calcitonin group showed statistically significantly higher bone mineral density values (all p values < 0.05), in all recorded sites, at 3 months and one-year post operatively. After a four years clinical follow-up, five patients (5/25, 20%) sustained a new fracture of the contralateral hip in the placebo group.

Conclusion: Nasal salmon calcitonin prevented early bone loss in these patients and may have a protective role on the occurrence of a new fracture of the contralateral hip in the same patient.