Summary
Injectable salmon calcitonin has been in use in the United States for more than a decade for the treatment of patients with postmenopausal osteoporosis, Paget's disease, and hypercalcemia, Sandoz Pharmaceuticals Corp. is currently in the process of developing a nasal formulation of salmon calcitonin. Studies are in progress to compare the efficacy of this nasal formulation with that of the injectable hormone in preventing bone loss and restoring bone, as well as in reducing pain associated with bone diseases. The rationale for development of a nasal formulation is to attempt to reduce the incidence of systemic side effects, inconvenience, and resulting noncompliance associated with the injectable product. In studies to date, the nasal form of calcitonin has been well tolerated by most subjects and was not notably associated with nasal irritation. The tolerability seen within the context of clinical trials suggests that a nasal formulation might be well accepted, even among asymptomatic osteoporotic patients. Asymptomatic patients with secondary osteoporosis due to steroid administration or solid organ transplantation may also be studied as possible candidates for the prophylactic use of this drug. Additional future research includes the development of an oral calcitonin agent.
Similar content being viewed by others
References
Azria M (1989) The calcitonins: physiology and pharmacology. Karger, Basel, pp 1–152
Guttman S (1980) Chemistry and structure-activity-relationship of natural and synthetic calcitonins. In: Pecile A (ed) Calcitonin 1980 chemistry, physiology, pharmacology and clinical aspects. Excerpta Medica, Amsterdam, pp 11–24
Morikawa T, Munekata E, Sakakibara S (1976) Synthesis of eel calcitonin and Asu eel calcitonin: contribution of the disulphide bond to the hormonal activity. Experientia 32:1104–1106
Potts JR, Aurbach GD (1976) Chemistry of the calcitonins. In: Greep RO, Astwood EB (eds) Handbook of physiology. American Physiological Society 7/7, p 423
Segre G, Bruni G, Dal Pra P (1985) Calcitonin pharmacokinetics. In: Pecile (ed) Calcitonin 1980: chemistry, physiology, pharmacology and clinical aspects. Excerpta Medica, Amsterdam, pp 99–107
Reginster JY, Gennari C, Mautalen C, et al (1990) Influence of specific anti-salmon calcitonin antibodies on biological effectiveness of nasal salmon calcitonin in Paget's disease of bone. Scand J Rheumatology 19:83–86
Gennari C, Gonnelli S, Chierichetti SM, et al (1985) Antibody problem in calcitonin administration. In: Pecile A (ed) Calcitonin. Elsevier Science Publishers BV, Amsterdam, pp 457–467
Gennari C, Agnusdei D (1989) Gain in bone mass and duration of antiresorptive treatment in established osteoporosis. Calcif Tissue Int 44 (suppl):S60
Heath H III, Sizemore GW (1977) Plasma calcitonin in normal man: differences between men and women. J Clin Invest 60:1135–1140
Milhaud G, Benezech-Lefevre M, Moukhtar MS (1980) Deficiency of calcitonin in age related osteoporosis. Biomedicine 29:272–276
Deftos LJ, Weisman H, Williams GW, et al (1980) Influence of age and sex on plasma calcitonin in human beings. N Engl J Med 302:1351–1353
Wallach S, Cohn SH, Atkins HL, et al (1977) Effect of salmon calcitonin on skeletal mass in osteoporosis. Curr Ther Res 22:556–572
Gruber HE, Ivey JL, Baylink DJ, et al (1984) Long-term calcitonin therapy in postmenopausal osteoporosis. Metabolism 33:295–303
Mazzuoli GF, Passeri M, Gennari C, et al (1986) Effects of salmon calcitonin in postmenopausal osteoporosis: a controlled double-blind clinical study. Calcif Tissue Int 38:3–8
Gennari C, Chierichetti SM, Bigazzi S, et al (1985) Comparative effects on bone mineral content of calcium and calcium plus salmon calcitonin given in two different regimens in postmenopausal osteoporosis. Curr Ther Res 38:455–464
Civitelli R, Gonnelli S, Zacchei F, et al (1988) Bone turnover in postmenopausal osteoporosis: effect of calcitonin treatment. Clin Invest 82:1268–1274
Melanotte PL, Caira S (1986) Salmon calcitonin effect on proximal femur fracture repair in elderly patients. Curr Ther Res 39:449–454
Avioli LV (1990) Calcitonin therapy in osteoporotic syndromes. JAMWA 45:103–107
Range JD, Welzel D (1987) Salmon calcitonin in the therapy of corticoid-induced osteoporosis. Eur J Pharm 33:35–39
Pasero GP, Gennari C, Di Munno O, et al (1985) Prevention of glucocorticoid-induced osteopenia by calcitonin. In: Pecile A (ed) Calcitonin 1984: chemistry, physiology, pharmacology and clinical aspects. Excerpta Medica, Amsterdam, pp 315–323
Gennari C (1983) Clinical aspects of calcitonin in pain. Triangle 22:157–163
Pecile A (1983) Calcitonin and pain relief. Triangle 22:147–155
Laurian L, Oberman Z, Graf E, et al (1986) Calcitonin induced increase in ACTH, β-endorphin and cortisol secretion. Horm Metabol Res 18:268–271
Levernieux J, Julien D, Caulin F (1984) A double blind study on the effect of calcitonin on pain and acute resorption related to recent osteoporotic crush fractures. In: Doepfner W (ed) Calcitonin 1984: selected short communications, International Calcitonin Symposium, Milan, 2–4 October 1984, Excerpta Medica, Amsterdam, pp 119–125
Chan KC, Fang D (1988) MiacalcicR (synthetic salmon calcitonin) in osteoporotic bone pain. In: Chestnut III CH (ed) Osteoporosis: epidemiology, clinical presentation, diagnosis and treatment. Excerpta Medica Asia Ltd, Hong Kong, pp 89–93
Lam KS (1988) Clinical evaluation of short term Miacalcic (synthetic salmon calcitonin) in osteoporotic bone pain. In: Chestnut III CH (ed) Osteoporosis: epidemiology, clinical presentation, diagnosis and treatment. Excerpta Medica Asia Ltd, Hong Kong, pp 81–86
Vinceneux PM, Pouchot JA (1989) Analgesic effect of salmon calcitonin in crushed vertebral fractures: double blind versus placebo studying 58 patients. J Bone Miner Res 4:(Suppl 1) S399
Gennari C, Chierichetti SM, Piolini M, et al (1985) Analgesic activity of salmon and human calcitonin against cancer pain: a double-blind, placebo-controlled clinical study. Curr Ther Res 38:298–308
Ustdal M, Dogan P, Soyuer A, et al (1989) Treatment of migraine with salmon calcitonin: effects on plasma beta-endorphin, ACTH and cortisol levels. Biomed Pharmacother 43:687–691
Miseria S, Torresi U, Piga A, et al (1989) Analgesia with epidural calcitonin in cancer patients. Tumori 75:183–184
Stevenson JC (1988) Current management of malignant hypercalcaemia. Drugs 36:229–238
Zanussi C, Marini U, Ferrini PLR, et al (1985) Calcitonin in multiple myetoma: a double blind controlled clinical trial. In: Pecile A (ed) Calcitonin 1984: chemistry, physiology, pharmacology and clinical aspects. Excerpta Medica, Amsterdam, pp 379–388
Kimura S, Sato Y, Matsubara H, et al (1986) A retrospective evaluation of the medical treatment of malignancy-associated hypercalcaemia. Jap J Can Res 77:85–91
Evans RA (1983) Treatment of Paget's disease of bone. Med J of Australia 1:159–163
Toh SH, Claunch BC, Brown PH (1978) Effect of calcitonin treatment on the natural course of bone demineralization in Paget's disease. J Clin Endo Metab 56:405–409
Nagant de Deuxchaisnes C, Rombouts-Lindermans C, Huaux JP, et al (1977) Roentgenologic evaluation of the efficacy of calcitonin in Paget's bone disease. In: MacIntyre I, Szelke M (eds) Molecular endocrinology. Elsevier North Holland Biomedical Press, Amsterdam, pp 213–233
Woodhouse NJ, Chalmers AH, Wells IP, et al (1977) Paget's disease. Radiological changes occurring in untreated patients and those on salmon calcitonin therapy during two years' observation. Br J Radiol 50:699–705
Data on file, Sandoz Pharmaceuticals.
Eisinger J (1987) Tolerance clinique de la calcitonine en function du mode d'administration. Revue du Rhumatisme 54:65–67
Reginster JY, Franchimont P (1985) Side effects of synthetic salmon calcitonin given by intranasal spray compared with intramuscular injection. Clin and Exp Rheum 3:155–157
Christiansen C, Riis BJ, Podenphant J, et al (1987) Intranasal calcitonin in the treatment of postmenopausal osteoporosis. In: Christiansen C, Johansen JS, Riis BJ (eds) Osteoporosis. Osteopress, Copenhagen, pp 853–856
Dambacher MA, Ruegsegger P, Goldmann AR, et al (1987) Treatment of postmenopausal osteoporosis with calcitonin nasal-spray evaluated with quantitative computed tomography. In: Christiansen C, Johansen JS, Riis BJ (eds) Osteoporosi 1987. Osteopress, Copenhagen, pp 1271–1272
Agnusdei D, Gonnelli S, Camporeale A, et al (1989) Clinical efficacy of treatment with salmon calcitonin, administered intranasally for 1 year, in stabilized postmenopausal osteoporosis. Minerva Endocrinologica 14:169–176
Overgaard K, Riis BJ, Christiansen C, et al (1989) Nasal calcitonin for treatment of established osteoporosis. Clin Endo 30:435–442
Hesch RD, Busch U, Prokop M, et al (1989) Increase of vertebral density by combination therapy with pulsatile 1-38hPTH and sequential addition of calcitonin nasal spray in osteoporotic patients. Calcif Tissue Int 44:176–180
Reginster JY, Denis D, Albert A, et al (1987) One-year, controlled, randomized trial of prevention of early postmenopausal bone loss by intranasal calcitonin. Lancet 2:1481–1483
Overgaard K, Riis BJ, Christiansen C (1988) The role of intranasal calcitonin in the treatment and prophylaxis of postmenopausal osteoporosis. J Bone Min Res 3 (Suppl 1):S162
Pun KK, Chan LW (1989) Analgesic effect of intranasal salmon calcitonin in the treatment of osteoporotic vertebral fractures. Clin Therapeutics 11:205–209
Reginster JY, Albert A, Franchimont P (1985) Salmon calcitonin nasal spray in Paget's disease of bone: preliminary results in five patients. Calcif Tissue Int 37:577–580
Nagant de Deuxchaisnes C, Devogelaer JP, Huaux JP, et al (1985) Effect of a nasal spray of salmon calcitonin in normal subjects and in patients with Paget's disease of bone. In: Pecile A (ed) Calcitonin 1984. Elsevier Science Publishers. Amsterdam, pp 329–343
Giustina A, Macca C, Romanelli G, et al (1989) Salmon calcitonin nasal spray in the treatment of Paget's disease 80:599–602
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Carstens, J.H., Feinblatt, J.D. Future horizons for calcitonin: A U.S. perspective. Calcif Tissue Int 49 (Suppl 2), S2–S6 (1991). https://doi.org/10.1007/BF02561368
Issue Date:
DOI: https://doi.org/10.1007/BF02561368