Calcitonin Therapy for Osteoporotic Fractures

Dosing Recommendations

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 or as suppositories, according to the American Academy of Orthopaedic Surgeons 1, 2, 3
100 IU subcutaneously or intramuscularly every other day can be used as an alternative to nasal spray, as recommended by the American Academy of Family Physicians 4

For acute vertebral compression fractures, 4 weeks is the recommended initial treatment period, as suggested by the American Academy of Orthopaedic Surgeons 1, 2, 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, according to the American Academy of Orthopaedic Surgeons 2

Calcitonin should be initiated within 0-5 days after an identifiable event or onset of symptoms in patients with osteoporotic spinal compression fractures, as recommended by the American Academy of Orthopaedic Surgeons 1, 2
Calcitonin should be used only in postmenopausal women with less serious osteoporosis who cannot tolerate other treatments, according to the American Academy of Family Physicians 4
In women more than five years past menopause, 200 IU daily nasal spray is the recommended dose, as suggested by the American Academy of Family Physicians 4

Side effects of calcitonin include mild dizziness, as reported by the American Academy of Orthopaedic Surgeons 2
Calcitonin is contraindicated in patients with allergy to calcitonin-salmon or synthetic calcitonin-salmon, as stated by the American Academy of Family Physicians 4

Calcium and vitamin D supplementation should be given concurrently with calcitonin therapy, as recommended by the American Gastroenterological Association 5
For patients with established osteoporosis, combination therapy with calcitriol, calcium, and calcitonin may improve bone density, according to the British Society of Gastroenterology 6, 7

The American Geriatrics Society notes that side effects of calcitonin are generally mild and include dizziness, nausea, and altered serum calcium and phosphorus levels, and assessment of calcium and phosphorus levels may be advisable during treatment 8

The British Society of Gastroenterology recommends measuring bone mineral density (BMD) yearly while on calcitonin treatment to guide duration decisions, with treatment continued for at least 3 years and possibly longer if osteoporosis persists 9, 10
For established osteoporosis, calcitonin should be continued for at least 3 years, with the caveat that current clinical experience with bisphosphonates and calcitonin is confined to 5 years of documented safety 9

If BMD falls more than 4% per year over two successive years, switch to an alternative drug, such as a bisphosphonate 9, 10
If BMD remains stable or improves, continue treatment for the minimum 3-year period 9
After stopping calcitonin, if yearly BMD falls more than 4%, restart the medication 9, 10

Calcitonin is significantly more expensive than bisphosphonates, approximately 8 times more expensive than alendronate and 16 times more expensive than etidronate 9
The optimum duration of treatment is not definitively known, but treatment should be guided by ongoing BMD monitoring and clinical response, with reassessment at least every 3-5 years 9