Recommended Calcitonin Dosage for Patients with Fractures
For patients with acute osteoporotic spinal compression fractures, calcitonin should be administered at a dose of 200 IU daily for 4 weeks, either as nasal spray (alternating nostrils daily) or as suppositories. 1
Dosing Recommendations by Route of Administration
Nasal Spray Administration
- 200 IU (one spray) per day administered intranasally, alternating nostrils daily 2
- The nasal spray bottle should be kept at room temperature between 20°C to 25°C (68°F to 77°F) in an upright position after opening 2
- Prime the pump before first use by holding the bottle upright and depressing the pump until a full spray is emitted 2
- Do not prime before each daily dose as this wastes medication 2
Parenteral Administration
- 100 IU subcutaneously or intramuscularly every other day can be used as an alternative to nasal spray 1
- For acute pain management in vertebral fractures, 50-100 IU daily subcutaneously has shown benefit 3
Duration of Treatment
- For acute vertebral compression fractures: 4 weeks is the recommended initial treatment period 1
- Pain relief typically occurs within the first 2 weeks and can continue for at least 4 months 3
- For longer-term treatment in established osteoporosis, nasal calcitonin in a 2-month-on and 2-month-off fashion for up to 12 months has shown benefit 1
Clinical Benefits and Considerations
Pain Management
- Calcitonin provides rapid onset and strong analgesic effect in patients with acute vertebral fractures 3, 4
- Pain is significantly lower in the first week of treatment with salmon calcitonin (100-200 IU daily) compared to control groups 4
- The number needed to treat for pain relief is approximately two patients 4
Bone Mineral Density Effects
- Prolonged administration of nasal calcitonin at 200 IU daily can increase lumbar spine bone mineral density by 1.7%-3.3% after 1 year 5
- The PROOF study demonstrated that 200 IU daily nasal calcitonin reduced the risk of new vertebral fractures by 33% 6
Specific Patient Populations
Osteoporotic Spinal Compression Fractures
- Calcitonin should be initiated within 0-5 days after an identifiable event or onset of symptoms 1
- Only use in neurologically intact patients 1
Postmenopausal Women
- Calcitonin should be used only in women with less serious osteoporosis who cannot tolerate other treatments 1
- In women more than five years past menopause, 200 IU daily nasal spray is the recommended dose 1
Patients with Hip Fractures
- 200 IU salmon calcitonin nasal spray twice daily for 12 months has shown benefits in postmenopausal women following total hip arthroplasty 7
- This regimen promotes independence, mobility, and reduces fear of falls 7
Side Effects and Contraindications
- Side effects of calcitonin include mild dizziness 1
- Nasal calcitonin is better tolerated than injectable forms, with side effects being rare and generally negligible 5
- Contraindicated in patients with allergy to calcitonin-salmon or synthetic calcitonin-salmon 1