Clinical outcome of salmon calcitonin nasal spray treatment in postmenopausal women after total hip arthroplasty.
OBJECTIVE
The increasing rate of hip fractures is giving rise to a number of socio-economic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip fractures, being performed increasingly often throughout the world. Revision rates for THA range up to 20% per year. Aseptic loosening is the reason for 75% of the revisions. An additional problem post-THA is the rate of heterotopic soft tissue calcification after THA, resulting in severely impaired function, pain, and a reduced range of hip movement.


METHODS
In an open study, 37 women who had undergone cementless THA after accidental hip fractures were treated twice daily with 200 IU of salmon calcitonin nasal spray for 12 months. Simultaneously the patients received one bag of 1,000 mg calcium plus 880 IU vitamin D daily throughout the treatment period of 1 year. A parallel group of 38 women with a similar clinical status in terms of hip fractures and cementless THA were treated with only one bag of 1,000 mg calcium plus 880 IU vitamin D daily through the treatment period.


RESULTS
The results of this 12-month clinical trial show that 200 IU of salmon calcitonin nasal spray per day significantly improves the clinical outcome of postmenopausal elderly women following THA. Treatment with a salmon calcitonin nasal spray significantly reduces bone turnover, loss of bone density, and pain. The functional status of the patients was improved and the risk of falling reduced by rehabilitation during the observation period of 12 months. Additionally, calcitonin promoted the repair of hip fractures and was associated with a significantly lesser rate of refractures as well as periprosthetic ossifications.


CONCLUSIONS
The increasing revision rate for THA during the first year and the patient's problem of resuming their previous living habits are the main foci of our study. Calcitonin nasal spray seems to cause few side effects. The additive treatment appears to improve the clinical outcome of THA in elderly postmenopausal women.
Second Department of Internal Medicine with Rheumatology and Osteology, Kaiser Franz Joseph Hospital, Vienna, Austria. peter.peichl@wienkav.at
P
P
Peichl
A
A
Griesmacher
W
W
Kumpan
R
R
Schedl
E
E
Prosquil
H
H
Bröll
D000281:Administration, Intranasal; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D015519:Bone Density / Q000187:drug effects*; D016723:Bone Remodeling / Q000187:drug effects; D002114:Calcinosis / Q000517:prevention & control; D002116:Calcitonin / Q000008:administration & dosage*; D005260:Female; D006620:Hip Fractures / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D010014:Osteolysis / Q000517:prevention & control; D017698:Postmenopause; D011446:Prospective Studies; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome
C028815:salmon calcitonin; D002116:Calcitonin