Calcitonin in the prevention and treatment of osteoporosis
- Harold N Rosen, MD
Harold N Rosen, MD
- Assistant Professor in Medicine
- Harvard Medical School
- Section Editors
- Clifford J Rosen, MD
Clifford J Rosen, MD
- Section Editor — Bone Disease
- Professor of Nutrition
- University of Maine
- Professor of Medicine
- Tufts University School of Medicine
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Osteoporosis is a disorder of bone characterized by reduced mineral density and bone mass (see "Pathogenesis of osteoporosis"). Multiple therapeutic regimens have been designed to prevent and treat osteoporosis in men and women by inhibiting bone resorption and/or increasing bone formation. The efficacy of calcitonin in the prevention and treatment of osteoporosis will be reviewed here. We do not use calcitonin as first-line therapy because more effective drugs are available for prevention of bone loss and reduction of fracture risk. (See "Overview of the management of osteoporosis in postmenopausal women".)
PREPARATIONS AND ROUTE OF ADMINISTRATION
Calcitonin is a peptide composed of 32 amino acids that binds to osteoclasts and inhibits bone resorption [1,2]. Calcitonins from many species are effective in humans, but salmon calcitonin is the one most widely used. It is highly potent in humans because of its high affinity (40 times that of human calcitonin) for the human calcitonin receptor and its slow rate of clearance . The only other calcitonin used clinically is human calcitonin, which is less potent but also less antigenic than salmon calcitonin. Most clinical trials of calcitonin have used salmon calcitonin, but human calcitonin is as effective .
Calcitonin is available in the United States for administration by the subcutaneous, intramuscular, and intranasal routes [1,4-9]. The bioavailability of nasal salmon calcitonin is only about 25 percent that of intramuscular calcitonin; thus, the biological effect of 50 international units of intramuscular salmon calcitonin is equivalent to that of 200 international units of nasal salmon calcitonin . There are also several other differences between the different preparations:
●The absorption of the nasal dose is delayed compared with the parenteral route .
●The administration of salmon calcitonin frequently is associated with side effects such as nausea, vomiting, and flushing; these side effects are much less common with the nasal route [1,11].
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