Calcitonin (FORTICAL, MIACALCIN) for the treatment of vertebral compression fractures

Abstract

Osteoporosis is a common condition affecting the musculoskeletal system. It carries with it increased risks of fracture in many areas of the body, leading to reduced quality of life, limited mobility, and other long-term implications such as chronic pain. Vertebral compression fractures are a common development in patients with osteoporosis. Current treatment options focus on reducing pain; preventative methods are somewhat limited and focus on minimizing risk factors for the development of osteoporosis. In this review, we explore the use of calcitonin (FORTICAL, MIACALCIN) to treat vertebral compression fractures (VCFs). Recent FindingsOsteoporosis had a prevalence of more than 10% in the United States in 2010. The CDC estimates that nearly 25% of women over age 65 have findings of osteoporosis, which include low spinal bone mass. The condition is highly prevalent and, in an aging U.S. population, quite clinically relevant. Risk factors for development include advanced age, cigarette smoking, medications, reduced physical activity, and low calcium and vitamin D intake. Family history may also play a role. Diagnosis is made based on bone mineral density. Standard therapy for VCFs in osteoporosis includes analgesic medications, such as NSAIDs and biphosphonates, and surgical intervention. NSAIDs address the chronic pain that is a common long-term effect of VCFs. Biphosphonates have recently been used to attempt to halt the progression and provide prevention. Surgical interventions such as balloon kyphoplasty and vertebroplasty are typically reserved for patients who have failed other methods. Calcitonin is a peptide naturally produced by the human body, released from the parathyroid gland. It binds to osteoclasts, inhibiting them from inducing bone resorption. By relatively unknown mechanisms, it also appears to cause endorphin release and mitigate pain. Clinical data has shown safety and efficacy for exogenous calcitonin in reducing bone turnover and reducing VCF-induced pain.

Nose-to-Brain (N2B) Delivery: An Alternative Route for the Delivery of Biologics in the Management and Treatment of Central Nervous System Disorders

“…It is also used to treat uterine fibroids, to control ovarian stimulation during IVF, and as part of transgender hormone therapy. IN salmon calcitonin (Miacalcin™ or Fortical™) is a peptide approved by the FDA for the treatment of osteoporosis in women over the age of 50 [ 272 ]. Table 4 lists intranasally administered biologics available on the market.…”

The occurrence and development of vertebral osteoporosis regulated by IL-8

“…At present, minimally invasive treatment is basically adopted, which can provide rapid analgesia, improve vertebral height, shorten patients’ bed time, reduce complications, reduce mortality, and improve the quality of life of patients. [ 6 , 7 ] In cases where there has been a significant improvement following treatment or complete recovery, but there is a possibility of recurrence or worsening, such as in the context of vertebral osteoporotic fractures that have been cured but later reappear as vertebral osteoporotic fractures without the occurrence of new vertebral fractures, this situation is considered a relapse. Vertebral osteoporotic fractures and their relapse may be influenced by genetic regulation, leading to an increased risk of disease occurrence, as well as changes in the maintenance time from recovery to recurrence (MTRR).…”

Advances in Our Understanding of the Mechanism of Action of Drugs (including Traditional Chinese Medicines) for the Intervention and Treatment of Osteoporosis

“…The extent of hypocalcemia is positively correlated with the rate of bone resorption, and calcitonin antagonizes the increase in the blood calcium concentration by inhibiting the reabsorption of calcium and phosphorus ions by the renal tubules, thereby reducing the rate of bone resorption ( Copp & Cheney, 1962 ; Hedlund, Hulth, & Johnell, 1983 ). Unlike other anti-OP drugs, calcitonin has the unique advantage of having analgesic effects and can relieve acute and chronic pain caused by OP-related vertebral compression fractures ( Lyritis et al, 1997 ; Knopp-Sihota, Newburn-Cook, Homik, Cummings, & Voaklander, 2012 ; Terashima et al, 2019 ); the mechanism underlying this effect this remains unclear ( Kaneb, Berardino, Hanukaai, Rooney, & Kaye, 2021 ). Previous studies have shown that calcitonin may exert analgesic effects by the modulation of the central nervous system as well as neurotransmitter release and neurophysiology ( Pecile, Ferri, Braga, & Olgiati, 1975 ; Yamamoto, Tachikawa, & Maeno, 1981 ; Laurian et al, 1986 ).…”