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Calcitonin in the prevention and treatment of osteoporosis

Harold N Rosen, MD
Section Editors
Clifford J Rosen, MD
Kenneth E Schmader, MD
Deputy Editor
Jean E Mulder, MD


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".)


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 [1]. 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 [3].

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 [10]. There are also several other differences between the different preparations:

The absorption of the nasal dose is delayed compared with the parenteral route [10].

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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Literature review current through: Nov 2017. | This topic last updated: Oct 17, 2016.
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  1. Carstens JH Jr, Feinblatt JD. Future horizons for calcitonin: a U.S. perspective. Calcif Tissue Int 1991; 49 Suppl 2:S2.
  2. Eastell R. Treatment of postmenopausal osteoporosis. N Engl J Med 1998; 338:736.
  3. MacIntyre I, Stevenson JC, Whitehead MI, et al. Calcitonin for prevention of postmenopausal bone loss. Lancet 1988; 1:900.
  4. Reginster JY, Meurmans L, Deroisy R, et al. A 5-year controlled randomized study of prevention of postmenopausal trabecular bone loss with nasal salmon calcitonin and calcium. Eur J Clin Invest 1994; 24:565.
  5. Overgaard K, Riis BJ, Christiansen C, Hansen MA. Effect of salcatonin given intranasally on early postmenopausal bone loss. BMJ 1989; 299:477.
  6. Gennari C, Agnusdei D, Montagnani M, et al. An effective regimen of intranasal salmon calcitonin in early postmenopausal bone loss. Calcif Tissue Int 1992; 50:381.
  7. Overgaard K, Hansen MA, Jensen SB, Christiansen C. Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. BMJ 1992; 305:556.
  8. Overgaard K, Hansen MA, Nielsen VA, et al. Discontinuous calcitonin treatment of established osteoporosis--effects of withdrawal of treatment. Am J Med 1990; 89:1.
  9. Overgaard K, Riis BJ, Christiansen C, et al. Nasal calcitonin for treatment of established osteoporosis. Clin Endocrinol (Oxf) 1989; 30:435.
  10. Overgaard K, Agnusdei D, Hansen MA, et al. Dose-response bioactivity and bioavailability of salmon calcitonin in premenopausal and postmenopausal women. J Clin Endocrinol Metab 1991; 72:344.
  11. Reginster JY, Franchimont P. Side effects of synthetic salmon calcitonin given by intranasal spray compared with intramuscular injection. Clin Exp Rheumatol 1985; 3:155.
  12. Civitelli R, Gonnelli S, Zacchei F, et al. Bone turnover in postmenopausal osteoporosis. Effect of calcitonin treatment. J Clin Invest 1988; 82:1268.
  13. Rico H, Revilla M, Hernández ER, et al. Total and regional bone mineral content and fracture rate in postmenopausal osteoporosis treated with salmon calcitonin: a prospective study. Calcif Tissue Int 1995; 56:181.
  14. Chesnut CH 3rd, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med 2000; 109:267.
  15. Gruber HE, Ivey JL, Baylink DJ, et al. Long-term calcitonin therapy in postmenopausal osteoporosis. Metabolism 1984; 33:295.
  16. Sileghem A, Geusens P, Dequeker J. Intranasal calcitonin for the prevention of bone erosion and bone loss in rheumatoid arthritis. Ann Rheum Dis 1992; 51:761.
  17. Mazzuoli GF, Passeri M, Gennari C, et al. Effects of salmon calcitonin in postmenopausal osteoporosis: a controlled double-blind clinical study. Calcif Tissue Int 1986; 38:3.
  18. Downs RW Jr, Bell NH, Ettinger MP, et al. Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. J Clin Endocrinol Metab 2000; 85:1783.
  19. Knopp-Sihota JA, Newburn-Cook CV, Homik J, et al. Calcitonin for treating acute and chronic pain of recent and remote osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Osteoporos Int 2012; 23:17.
  20. Lyritis GP, Tsakalakos N, Magiasis B, et al. Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study. Calcif Tissue Int 1991; 49:369.
  21. Gennari C, Agnusdei D, Camporeale A. Use of calcitonin in the treatment of bone pain associated with osteoporosis. Calcif Tissue Int 1991; 49 Suppl 2:S9.
  22. Lyritis GP, Ioannidis GV, Karachalios T, et al. Analgesic effect of salmon calcitonin suppositories in patients with acute pain due to recent osteoporotic vertebral crush fractures: a prospective double-blind, randomized, placebo-controlled clinical study. Clin J Pain 1999; 15:284.
  23. Lyritis GP, Paspati I, Karachalios T, et al. Pain relief from nasal salmon calcitonin in osteoporotic vertebral crush fractures. A double blind, placebo-controlled clinical study. Acta Orthop Scand Suppl 1997; 275:112.
  24. Lufkin EG, Wahner HW, O'Fallon WM, et al. Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med 1992; 117:1.
  25. Watts NB, Harris ST, Genant HK, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 1990; 323:73.
  26. European Medicines Agency recommends limiting long-term use of calcitonin medicines http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/public_health_alerts/2012/07/human_pha_detail_000065.jsp&mid=WC0b01ac058001d126 (Accessed on October 17, 2012).
  27. Background Document for Meeting of Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management Advisory Committee. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdf (Accessed on March 06, 2013).
  28. http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021406s017s022lbl.pdf (Accessed on July 14, 2014).