1322 - Making the Case for Intranasal Calcitonin Use in Inpatient Rehabilitation

Case Diagnosis: Making the Case for Intranasal Calcitonin (IC) Use in Inpatient Rehabilitation

Case Description:
Two elderly females were admitted to inpatient acute rehabilitation, one with critical illness myopathy and back pain, and the other with pathological fractures. Both experienced uncontrolled pain, causing a reduction in rehabilitation participation. Both patients were started on intranasal calcitonin (IC) for bone pain management.  


 


Case A 



79-year-old female with toxic megacolon complicated by enterocutaneous fistulas; therefore, she was unable to take oral medications. Her rehabilitation was limited by exacerbated low back pain. 



Case B 



75-year-old female with metastatic breast cancer, admitted with pathological femoral neck fracture status post repair and cervical neck fracture managed conservatively. Additionally, she was found to have radius and humerus pathological fractures. Pain became a primary barrier to participation. Opiates were not tolerated due to sedation.


Discussions: IC was initially approved for use in the treatment of postmenopausal osteoporosis. Initial studies on rats elucidated the possibility of decreased nociceptive transmission by upregulation of 5-HT1a receptors. Although studies in the early 2000s showed that salmon-derived calcitonin was associated with a slight increase in the incidence of malignancies, in 2016, a subsequent meta-analysis found no direct correlation, and the recommendations were updated to support its use for short-term bone pain. The recommended 4-week course of intranasal calcitonin showed superior short-term pain relief compared with bisphosphonates, teriparatide, and placebo.  

Conclusions: These two cases highlight the safety and efficiency of intranasal calcitonin in cancer-related and non-cancer-related bone pain, while maximizing participation in therapy. In case A, the rehabilitation goals centered around increasing mobility and independence. In case B, goals shifted to comfort care and family training to support quality of life during transition to hospice care. These cases support the use of IC as an additional consideration for pain control and increased therapy participation in the inpatient rehabilitation setting.