At what age should calcitonin (calcitonin) be stopped?

Calcitonin Therapy Duration Guidelines

Calcitonin therapy should be continued for at least three years, and possibly for as long as osteoporosis persists, with yearly bone mineral density (BMD) measurements to monitor response. 1

Monitoring and Duration Protocol

• BMD should be measured yearly while on calcitonin treatment to assess effectiveness 1
• If BMD falls >4% per year in two successive years, treatment should be changed to another drug 1
• If no deterioration is observed, calcitonin should be continued for at least three years 1
• After three years, treatment may be continued for as long as osteoporosis persists 1
• If BMD deteriorates at yearly measurement after stopping calcitonin, the treatment should be restarted 1

Administration Patterns

• For long-term treatment of established osteoporosis, a cyclical or discontinued administration pattern may be beneficial 2
• A 2-month-on and 2-month-off pattern for up to 12 months has shown benefit according to clinical guidelines 3
• Discontinuous therapy with a ratio between periods with and without treatment between 1:2 and 2:3 may provide optimum response, particularly for forearm bone density 4
• Cyclical administration may help delay or avoid resistance to calcitonin that can occur after 12-18 months of continuous treatment 2

Patient-Specific Considerations

• For acute vertebral compression fractures, a shorter 4-week treatment period is recommended 3
• For postmenopausal women with less serious osteoporosis who cannot tolerate other treatments, calcitonin may be used long-term 3
• In men over 55 years with osteoporosis, especially those with fragility fractures, calcitonin should be considered if testosterone is normal or if BMD does not improve on testosterone replacement 1

Dosing Recommendations

• Standard dosing is 200 IU daily via nasal spray for long-term treatment 3, 5
• Alternative dosing includes 100 IU subcutaneously or intramuscularly every other day 3, 6
• Calcium supplementation (500-1000 mg daily) should be given concurrently with calcitonin therapy 3, 4

Practical Considerations

• Nasal calcitonin is better tolerated than injectable forms, with rare and generally negligible side effects 5
• The effectiveness of calcitonin may diminish over time due to receptor down-regulation, making cyclical therapy potentially more effective 2
• Current evidence suggests that calcitonin provides modest increases in BMD (1-3.3% at lumbar spine after 1 year) 5
• The PROOF study demonstrated a 33% reduction in new vertebral fractures with 200 IU daily nasal calcitonin 5

Caveats and Limitations

• Experience with bisphosphonate treatment is limited to five years, suggesting a similar timeframe might be appropriate for calcitonin 1
• Calcitonin is significantly more expensive than bisphosphonates (approximately eight times more expensive than alendronate) 1
• The optimal duration of treatment is not definitively established, and recommendations are based on limited long-term studies 1