What is the use of calcitonin (Calcitonin) nasal spray?

From the Guidelines

Calcitonin nasal spray is a viable treatment option for osteoporosis in postmenopausal women who cannot use other osteoporosis treatments, with a typical dosage of 200 IU (one spray) in one nostril daily, alternating nostrils each day, as supported by 1. The treatment duration varies but is often reassessed after 3-6 months. Before starting, patients should have their nasal passages examined and should be instructed on proper administration technique. Some key points to consider when prescribing calcitonin nasal spray include:

• Side effects commonly include nasal irritation, rhinitis, and headache
• Patients should be advised to store the medication in the refrigerator before opening but at room temperature after first use
• Calcitonin works by inhibiting bone resorption by osteoclasts, thereby helping to maintain bone density
• It may also provide analgesic effects for bone pain, particularly in cases of vertebral fractures
• Due to concerns about a possible small increased risk of cancer with long-term use, calcitonin nasal spray is generally considered a second-line treatment when other options cannot be used or tolerated, as noted in 1. The use of calcitonin nasal spray has been studied in various contexts, including its comparison to other treatments such as bisphosphonates and selective estrogen receptor modulators, as discussed in 1 and 1. However, the most relevant and recent guidance on the use of calcitonin nasal spray for osteoporosis treatment is provided in 1, which outlines the approved therapies for osteoporosis prevention and treatment, including calcitonin nasal spray.

From the FDA Drug Label

The recommended dose of CALCITONIN-SALMON Nasal Spray is one spray daily in alternated nostrils – unless directed otherwise by your healthcare provider Start with a spray in the left nostril on your first day, followed by a spray in the right nostril on the second day. Continue to alternate nostrils every day. The dosage of Calcitonin nasal spray is one spray daily in alternated nostrils.

• The patient should start with a spray in the left nostril on the first day,
• followed by a spray in the right nostril on the second day,
• and continue to alternate nostrils every day 2. It is also recommended to take at least 1000 mg of calcium and 400 I.U. of vitamin D each day while using Calcitonin-Salmon Nasal Spray 2 2.

From the Research

Calcitonin Nasal Spray Overview

• Calcitonin nasal spray is FDA approved for the treatment of postmenopausal osteoporosis, but not for prevention 3.
• The preferred delivery system for calcitonin is nasal, which is safe and well tolerated 3, 4.

Efficacy and Safety

• Calcitonin has been shown to increase lumbar spine bone mass and reduce bone turnover in women with osteoporosis 3, 4.
• The vertebral fracture efficacy of calcitonin is less robust than bisphosphonates, but similar to raloxifene in the treatment of established osteoporosis 3.
• Calcitonin may have analgesic benefits in patients with acute painful vertebral fractures 3, 5.
• Nasal calcitonin has been shown to be effective in preventing further bone mass loss in patients on long-term glucocorticoid therapy for asthma 6.

Treatment Regimens and Dosage

• The dose for established osteoporosis is 200 IU/day 4.
• Different treatment regimens with nasal S-calcitonin spray have been studied, including continuous and cyclic therapy 7.
• A dose-effect relationship exists when comparing dosages of 100 IU/day and 200 IU/day, but this disappears by one year after completion of therapy 7.

Analgesic Effect

• Calcitonin has been shown to significantly reduce bone pain in osteoporosis, with the analgesic effect evident as soon as the second week of treatment 5.
• The mechanism for the analgesic effect of calcitonin is yet to be clarified, but may involve the endogenous opiate system or direct modulation of nociception in the central nervous system 5.