What is the recommended dose of Calcitonin (thyrocalcitonin)?

From the Guidelines

Calcitonin should be administered at a dose of 100 IU daily via subcutaneous or intramuscular injection for the treatment of osteoporosis, as the nasal spray formulation is not generally available, as noted in the guidelines by the British Society of Gastroenterology 1. The treatment with calcitonin is usually given in conjunction with 500 mg of calcium daily.

• The use of calcitonin may also provide relief from osteoporotic bone pain, and it has been shown to be safe with no serious or long-term side effects, according to the study published in Gut 1.
• However, it is essential to consider the high cost of calcitonin, which is roughly eight times more expensive than alendronate and sixteen times more expensive than etidronate, as highlighted in the guidelines 1.
• The decision to use calcitonin should be made on a case-by-case basis, taking into account the potential benefits and drawbacks, as well as the availability of alternative treatments, such as bisphosphonates, which may be more cost-effective and have a more established efficacy profile.
• It is crucial to weigh the potential benefits of calcitonin against its high cost and the availability of alternative treatments, as noted in the study 1.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

2.1 Paget's Disease of Bone The recommended dose of calcitonin-salmon injection for treatment of symptomatic Paget’s disease of bone is 100 International Units (0.5 mL) per day administered subcutaneously or intramuscularly. 2.2 Hypercalcemia The recommended starting dose of calcitonin-salmon injection for early treatment of hypercalcemia is 4 International Units/kg body weight every 12 hours by subcutaneous or intramuscular injection. 2.3 Postmenopausal Osteoporosis The recommended dose of calcitonin-salmon injection for treatment of postmenopausal osteoporosis in women greater than 5 years postmenopause is 100 International Units (0.5 mL) per day administered subcutaneously or intramuscularly.

The recommended calcitonin dose varies depending on the condition being treated:

• Paget's Disease of Bone: 100 International Units (0.5 mL) per day
• Hypercalcemia: 4 International Units/kg body weight every 12 hours (may be increased to 8 International Units/kg every 12 hours or 8 International Units/kg every 6 hours if response is not satisfactory)
• Postmenopausal Osteoporosis: 100 International Units (0.5 mL) per day 2 2

From the Research

Calcitonin Dose Information

• The optimal dose of calcitonin for the prevention and treatment of osteoporosis is not universally established, but several studies provide insight into effective dosing regimens 3, 4, 5.
• A dose of 200 IU of intranasal calcitonin daily has been shown to increase lumbar spine bone mineral density (BMD) by 1%-2% after 1 year and reduce the risk of vertebral osteoporotic fractures by 33% 3, 4.
• Lower doses of calcitonin, such as 100 IU daily, may also be effective in preventing early postmenopausal bone loss, but the data are conflictual 3.
• The PROOF study, a 5-year double-blind, randomized, placebo-controlled trial, demonstrated that 200 IU/day of salmon calcitonin nasal spray reduced the risk of vertebral osteoporotic fractures, but 100 and 400 IU/day dosages did not significantly reduce vertebral fracture risk 4.
• Calcitonin has also been found to reduce acute pain associated with osteoporotic fractures and may be effective in treating chronic back pain following vertebral fractures in spinal osteoporosis 5.

Comparison with Other Treatments

• Bisphosphonates, another class of osteoporosis treatments, have been shown to reduce the risk of fracture by suppressing bone resorption and increasing bone strength 6, 7.
• Calcitonin and bisphosphonates have different mechanisms of action, and calcitonin may be beneficial in reducing bone pain associated with fractures, whereas bisphosphonates have been shown to increase bone mineral density and reduce fracture rates 7.

Key Findings

• The efficacy of calcitonin in reducing fracture risk is most consistently demonstrated at a dose of 200 IU/day 3, 4.
• Calcitonin may be a useful treatment option for patients with osteoporosis who experience bone pain or have a high risk of vertebral fractures 4, 5.
• Further trials are needed to assess the long-term efficacy of calcitonin in preventing fractures and to determine the optimal dose range for treating pain and increasing bone mineral density 5.