For more than 20 years, calcitonin has been used in the treatment of Paget’s disease. With long-term administration of the hormone, two main patterns of biochemical response have been observed.1 In most patients, serum alkaline phosphatase activity and urinary hydroxyproline excretion fall over a period of months and reach a plateau at an average reduction of about 50% below pretreatment levels. Biochemical indexes may remain suppressed to this degree for more than 10 years as treatment continues (Figure 7.1). In a smaller group of patients after an initial period of typical biochemical suppression, the indices gradually rise, and with continuing treatment they reach pretreatment or even higher levels (Figure 7.2). This latter pattern of acquired clinical resistance appears to occur most commonly when salmon or porcine calcitonin is administered, but a similar clinical course has been observed in a few patients on human calcitonin therapy. Primary clinical resistance may occur but appears to be unusual.
KeywordsSalmon Calcitonin Clinical Resistance Calcitonin Receptor Human Calcitonin Serum Alkaline Phosphatase Activity
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