Salmon Calcitonin: A forgotten treatment for spine and pelvic fragility fractures; an audit of standard treatment versus Salmon Calcitonin

Abstract

Fragility fractures of the pelvis and spine cause significant pain and disability requiring a hospital length of stay of 15-45 days following which independence is often adversely affected. In 2018, the estimated cost to the NHS of such admissions was £4.4 billion per year. Fragility fractures are predicted to rise from the current 23% of the retired population to above 50% by 2030. This will place an enormous stress on NHS bed occupancy and subsequent home support if independence is affected. In 1961 the beneficial effects of salmon calcitonin (SCT) in treating fractures were first described and clinical trials confirmed its efficacy in reducing pain and accelerating fracture healing. This treatment option has now been largely forgotten as the focus has shifted to prevention by diagnosing and treating osteoporosis as per the National guidelines. In this quality audit we examined cases admitted with fragility fractures of the spine and pelvis from 1st Jan 2021-1st Jan 2022 and examined the recorded hospital admission and length of stay, treatments given and independence at discharge. When standard treatment (n=97) was compared with the patients also prescribed subcutaneous SCT (n=18) differences in outcome were seen. SCT treatment showed a 50% reduction in length of stay along with reduced requirement for powerful painkillers and 78% of these patients were discharged home without care requirements in comparison to only 18% on standard treatment alone. We discuss the audit findings and review the known data on SCT’s action and benefit in fragility fractures.