Calcium Metabolism and 47Calcium Kinetics before and after Long-Term Thyrocalcitonin Treatment in Senile Osteoporosis

Caniggia, A; Gennari, C; Bencini, M.; Cesari, L; Borrello, G

doi:10.1042/cs0380397

Cited by 56 publications

(13 citation statements)

References 14 publications

(10 reference statements)

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“…The notion of a stimulatory effect of salmon CT on synthesis or release of calcitriol has considerable support from animal experiments (18)(19)(20), but in man these spe¬ cific hormonal interactions are still not elucidated with either nasal or injectable CT. It should be noted, that serum levels of calcitriol are elevated in patients with medullary carcinoma of the thyroid with excess serum levels of hCT (21), and that increased intestinal calcium absorption has been re¬ ported during treatment with porcine CT, suggest¬ ing that an increase in the serum levels of calcitriol takes place (22).…”

Section: Discussionmentioning

confidence: 99%

Circulating levels of calciotropic hormones during treatment with nasal salmon calcitonin

Thamsborg¹,

Storm²,

Daugaard³

et al. 1991

Acta Endocrinologica

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Circulating levels of calciotropic hormones were measured during one year of treatment with either 200 IU of salmon calcitonin daily or placebo as a nasal spray in 20 postmenopausal women with a former Colles' fracture. A supplement of 0.5 gram elemental calcium was given to all participants. Serum levels of parathyroid hormone and human calcitonin were determined with radioimmunoassays, and serum levels of vitamin D metabolites were determined with protein binding assays. We did not find any significant differences between the two groups with respect to serum levels of calciotropic hormones. In the salmon calcitonin treated group there was a tendency towards a small decrease in serum levels of human calcitonin and an increase in serum levels of calcitriol. Our results suggest that treatment with 200 IU of salmon calcitonin daily as a nasal spray does not markedly affect fasting serum levels of parathyroid hormone, human calcitonin, and vitamin D metabolitis.Several clinical trials have shown that treatment with nasal calcitonin (CT) is able to increase bone mass in postmenopausal women, and as the treat¬ ment is well tolerated and without major side ef¬ fects, nasal CT may well become an attractive ther¬ apy in osteoporosis in the future (1-4). Treatment with nasal CT may affect synthesis and secretion of calciotropic hormones either di¬ rectly, or indirectly through changes in serum levels of calcium and phosphate. However, at present our knowledge of these hormonal interac¬ tions is very scant. We hereby report on changes in circulating levels of parathyroid hormone (PTH), calcitriol, calcidiol, and human CT from a treat¬ ment regimen with nasal salmon CT, which resuited in a significant increase in spinal bone mass (4). Patients and MethodsIn total, 20 healthy women, aged 51-75, with a former Colles' fracture were enrolled over 6 months. All had passed a spontaneous menopause at least 12 months prior to inclusion. Presence of malignant disease and general¬ ized bone diseases other than osteoporosis resulted in ex¬ clusion. Informed consent was obtained from each indi¬ vidual according to the Helsinki II Declaration, and the protocol was approved by the local Ethical Committee. The participants were randomly assigned to one year of treatment with either placebo or 200 IU of salmon CT daily given as a nasal spray (Miacalcic®, nasal spray,

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Section: Discussionmentioning

confidence: 99%

Circulating levels of calciotropic hormones during treatment with nasal salmon calcitonin

Thamsborg¹,

Storm²,

Daugaard³

et al. 1991

Acta Endocrinologica

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“…With few exceptions (216,224,225), the former generally confirmed that CT reduces bone resorption and turnover (188, 195-198, 207, 214, 215, 226-231), while the effects on bone accretion were variable (196-198, 207, 214, 216, 226-230). Although intestinal calcium absorption was improved (195,197,198,214,215,(226)(227)(228)232) in all but 2 (207,229) reports, determinations of overall calcium balance were much less consistent being increased (196-198, 202, 226-229, 232), unchanged (188,207,(214)(215)(216)(217)(218)(219)233), or decreased (224,234).…”

Section: Ct and The Therapy Of Osteoporosismentioning

confidence: 92%

The Role of Calcitonin in the Development and Treatment of Osteoporosis*

McDermott

Kidd

1987

Endocrine Reviews

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CT is a peptide hormone produced predominantly by thyroid C cells and probably to a lesser extent by extrathyroidal tissues. Although its physiological function has not yet been established, it is a pharmacological inhibitor of osteoclastic bone resorption. There is currently no convincing evidence that naturally occurring or iatrogenic CT deficiency is involved in the pathogenesis of osteoporosis; however, a selective examination of patients with various rates of bone turnover would help to resolve this issue. As a pharmacological inhibitor of bone resorption, CT has potential usefulness in the therapy of osteoporosis. CT has been shown to stabilize or modestly increase indices of cortical and trabecular bone mass and total body calcium when administered to patients with established osteoporosis for periods of 1-2 yr. The increments in bone mass seen in some studies appear to be transient and are likely due to reductions in bone resorption with bone formation remaining unaffected until remodeling spaces are filled. The duration and magnitude of these increases are probably limited by the eventual decline in bone formation as remodeling equilibrium is reestablished. Therefore, reduction in the rate of bone loss with maintenance of the existing skeletal mass, rather than significant sustained increases in bone mass, should be considered the most realistic therapeutic goal with this agent. Whether or not a reduction in the rate of bone loss persists for longer periods needs further evaluation as does the important issue of subsequent fracture rates. The identification of patients with increased bone resorption rates (high turnover osteoporosis) should help provide a basis for more selective treatment of those patients who would be most likely to respond to this form of therapy. Whether there is additional benefit to using intermittent CT concurrently or sequentially with bone formation stimulating agents (coherence therapy) also needs to be explored. CT may also be of benefit in the prevention of osteoporosis, particularly in postmenopausal women who are unable or unwilling to take estrogen replacement. These potential benefits must be weighed carefully against the current cost of CT and the inconvenience of it having to be given by injection, problems which should be solved by future research.

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“…Injection of calci tonin has been reported to be effective in the treatment of postmenopausal osteoporosis in both short-term noncontrolled studies [22,23] and in long-term placebo-con trolled studies [24][25][26], Calcitonin therapy is especially indicated for patients with high turnover osteoporosis, where results show a net gain of bone mineral in the axial skeleton and a slowing of bone loss in the appendicular bones [27], Nasal administration of salmon calcitonin in established osteoporosis was evaluated in several double blind placebo-controlled studies. As for prevention of postmenopausal bone loss, studies were designed to eval uate the optimal dose of salmon calcitonin to be used in established osteoporosis.…”

Section: Calcitoninmentioning

confidence: 99%

Treatment of Bone in Elderly Subjects: Calcium, Vitamin D, Fluor, Bisphosphonates, Calcitonin

Reginster

1995

Horm Res

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Several approaches may be suggested for prevention or treatment of senile osteoporosis. In elderly patients, an association of calcium and vitamin D supplementation has been shown to reduce nonvertebral fractures up to 40% over an 18-month period. Calcitonin, given parenterally or nasally, may prevent further bone loss and has been reported to significantly decrease vertebral and hip fractures. This hormone also possesses an important analgesic effect. Fluoride salts are the most effective way to significantly increase bone mass, mainly at the trabecular site. The optimal doses and regimens remain to be clearly established. The use of new formulations like sodium monofluorophosphate are likely to facilitate the search of the optimal therapeutic window. Bisphosphonates are potent inhibitors of bone resorption. They have been shown to significantly increase trabecular bone mass without impairment of cortical bone. Their use may be associated with a significant decrease in vertebral fractures, mainly in patients with severe osteoporosis. The new, second and third generation of bisphosphonates (tiludronate, risedronate, alendronate) look extremely promising but their widespread use will only be possible after a confirmation of the absence of a deleterious effect on bone quality (alendronate) and after demonstration of a reduction in vertebral and/or hip fractures following a prolonged use.

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Calcium Metabolism and 47Calcium Kinetics before and after Long-Term Thyrocalcitonin Treatment in Senile Osteoporosis

Cited by 56 publications

References 14 publications

Circulating levels of calciotropic hormones during treatment with nasal salmon calcitonin

Circulating levels of calciotropic hormones during treatment with nasal salmon calcitonin

The Role of Calcitonin in the Development and Treatment of Osteoporosis*

Treatment of Bone in Elderly Subjects: Calcium, Vitamin D, Fluor, Bisphosphonates, Calcitonin

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