From the Guidelines
Calcitonin nasal spray should be used for a duration of up to 12 months for the treatment of vertebral fractures, as evidenced by a study showing possibly clinically important benefit in pain reduction using nasal calcitonin in a 2-month-on and 2-month-off fashion for 12 months, compared with calcium 500 mg with vitamin D 200 IU 1. The standard dosage is 200 IU (one spray) daily, alternating nostrils. Treatment should be accompanied by adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplementation.
- Key points to consider:
- Calcitonin provides modest pain relief for acute vertebral fractures within 2-4 weeks
- Its long-term effectiveness for preventing new fractures is limited compared to newer osteoporosis medications
- Side effects may include mild dizziness, nasal irritation, rhinitis, and headache
- Due to its limited anti-fracture efficacy and potential safety concerns, calcitonin is now considered a second or third-line therapy for osteoporosis, with bisphosphonates, denosumab, or anabolic agents generally preferred for long-term fracture prevention. The effect of subcutaneous administration of calcitonin is undetermined in a rigorous scientific manner, and two additional level II studies with calcitonin showed benefit at longer periods (3 to 12 months) but were not as well designed 1.
From the FDA Drug Label
The evidence of efficacy is based on increases in spinal bone mineral density observed in clinical trials Two randomized, placebo controlled trials were conducted in 325 postmenopausal females [227 Calcitonin-Salmon Nasal Spray treated and 98 placebo treated] with spinal, forearm or femoral bone mineral density (BMD) at least one standard deviation below normal for healthy premenopausal females. These studies conducted over two years demonstrated that 200 I. U. daily of Calcitonin-Salmon Nasal Spray increases lumbar vertebral BMD relative to baseline and relative to placebo in osteoporotic females who were greater than 5 years postmenopause Calcitonin-Salmon Nasal Spray produced statistically significant increases in lumbar vertebral BMD compared to placebo as early as 6 months after initiation of therapy with persistence of this level for up to 2 years of observation.
The duration of calcitonin nasal spray treatment for vertebral fracture is up to 2 years of observation, as demonstrated in clinical trials 2.
- The treatment produced statistically significant increases in lumbar vertebral BMD compared to placebo as early as 6 months after initiation of therapy.
- The persistence of this level was observed for up to 2 years of observation.
From the Research
Duration of Calcitonin Nasal Spray for Vertebral Fracture
- The duration of calcitonin nasal spray for vertebral fracture is typically several weeks, with studies showing efficacy in reducing pain and improving mobility over this period 3, 4.
- One study found that patients taking 200 IU of nasal salmon calcitonin daily for 28 days had a significant reduction in spinal pain and improvement in locomotor functions 3.
- A systematic review and meta-analysis found that calcitonin significantly reduced the severity of acute pain in recent osteoporotic vertebral compression fractures, with continued improvement through 4 weeks 4.
- The optimal duration of treatment with calcitonin nasal spray for vertebral fracture is not well established, but it is generally recommended for short-term use (several weeks to a few months) to manage acute pain and prevent further bone loss 5, 6.
Efficacy of Calcitonin Nasal Spray
- Calcitonin nasal spray has been shown to be effective in reducing pain and improving mobility in patients with osteoporotic vertebral fractures 3, 5, 4.
- The analgesic efficacy of calcitonin is thought to be due to its ability to reduce bone resorption and promote bone formation, as well as its direct effects on pain perception 5, 6.
- Calcitonin nasal spray has been compared to other treatments for osteoporosis, such as bisphosphonates, and has been found to have a similar efficacy in reducing vertebral fracture rates 6.
Safety and Side Effects
- Calcitonin nasal spray is generally well tolerated, with mild side effects such as enteric disturbances and flushing reported most frequently 4.
- The safety and efficacy of long-term use of calcitonin nasal spray for vertebral fracture is not well established, and further studies are needed to determine the optimal duration of treatment and potential risks associated with prolonged use 5, 6.