Table 14.

Effect of Calcitonin and Bisphosphonates on Neurological Symptoms

Risk‐benefit balance

Most experience in the medical treatment of spinal cord dysfunction in PDB comes from case series of patients treated with calcitonin, and clinical benefit from treatment has been reported in a proportion of treated patients. Similar benefit has been noted in a small number of patients treated with bisphosphonates.

Quality of evidence

Very low

Patient values and preferences

Spinal cord dysfunction and the symptoms associated with this complication is of major concern to patients. Treatment strategies that are effective in preventing spinal cord dysfunction are likely to be favored by patients.

Costs and use of resources

Calcitonin is a relatively expensive treatment that needs to be administered by injection. Bisphosphonates are inexpensive but have been little studied in this situation. Intravenous bisphosphonate therapy involves additional support costs and costs in terms of patient time attending for the infusion that may need to be considered.

Recommendation

A trial of calcitonin treatment may be considered as part of the treatment package in patients with PDB who have evidence of neurological dysfunction. Bisphosphonate treatment may also be considered, although there are few studies to support the use of bisphosphonates in this situation.