From the Guidelines
Calcitonin is not the preferred treatment for hypercalcemia, and its effectiveness in decreasing calcium levels is not well-established in recent studies. The most recent and highest quality study, 1, recommends bisphosphonates, such as zoledronic acid, as the first-line treatment for hypercalcemia, with denosumab as an alternative for refractory cases. Calcitonin, on the other hand, is not mentioned as a recommended treatment in this study.
Mechanism of Action
Calcitonin works by inhibiting osteoclast activity in bones, which reduces bone resorption and consequently lowers calcium release into the bloodstream. Additionally, calcitonin increases calcium excretion by the kidneys and decreases calcium absorption in the intestines.
Clinical Use
In clinical settings, synthetic calcitonin is sometimes used to treat hypercalcemia, Paget's disease, or osteoporosis, with dosages typically ranging from 4-8 IU/kg for hypercalcemia or 50-100 IU daily for osteoporosis, administered subcutaneously or intranasally. However, its use is limited due to the availability of more effective and safer alternatives, such as bisphosphonates.
Key Points
- Calcitonin is not the preferred treatment for hypercalcemia
- Bisphosphonates, such as zoledronic acid, are the recommended first-line treatment for hypercalcemia
- Denosumab is an alternative treatment for refractory cases of hypercalcemia
- Calcitonin's effectiveness in decreasing calcium levels is not well-established in recent studies, as seen in 1, 1, and 1.
Recommendation
Based on the most recent and highest quality study, 1, bisphosphonates, such as zoledronic acid, should be used as the first-line treatment for hypercalcemia, rather than calcitonin.
From the FDA Drug Label
The average reduction of 8 hour post-injection serum calcium was approximately 9% (2 to 3 mg/dL) Patients with higher values of serum calcium tended to show greater reductions during calcitonin-salmon treatment.
The calcitonin-salmon injection decreases serum calcium levels by an average of 9% (2 to 3 mg/dL) in patients with hypercalcemia.
- The peak effect occurs within 24 to 48 hours of injection.
- Administration of calcitonin-salmon every 12 hours maintains a hypocalcemic effect for approximately 5 to 8 days 2.
From the Research
Calcitonin's Effect on Calcium Levels
- Calcitonin has been shown to decrease serum calcium levels in certain hypercalcemic conditions 3
- However, its hypocalcemic effect in patients with renal osteodystrophy and hypercalcemia is inconsistent 3
- The decrease in calcium levels is more likely to occur in the presence of osteomalacia, while predominant osteitis fibrosa may favor a hypercalcemic response 3
Mechanism of Action
- Calcitonin inhibits osteoclasts activated bone resorption, which can be demonstrated in vivo and in vitro 4
- It is used to treat osteoporosis and algodystrophic syndrome, and has been shown to increase spine bone density and reduce the risk of new fractures 4
Clinical Use
- Calcitonin is used to treat hypercalcemia, particularly in cases of symptomatic or severe hypercalcemia 5, 6
- It is often used in combination with other treatments, such as bisphosphonates and corticosteroids 5
- Restrictions on calcitonin utilization have been implemented in some health systems to ensure appropriate use and reduce costs 6