The effect of intranasal salmon calcitonin on postmenopausal bone turnover as assessed by biochemical markers: Evidence of maximal effect after 8 weeks of continuous treatment

Abstract

Although treatment with intranasal salmon calcitonin (sCT) has been shown to effectively inhibit postmenopausal bone loss, there is still controversy over both timing and the duration of its application. In an open prospective study, we therefore assessed the effect of shortterm intranasal sCT on postmenopausal bone turnover, employing biochemical markers of bone metabolism. Ten early postmenopausal, previously untreated women (1-5 years after menopause) with biochemical evidence of increased bone resorption and a low bone mineral density at baseline were treated with intranasal sCT (100 IU B.I.D.) for a period of 3 months. Oral calcium (500 mg/day) was administered simultaneously, and during a further 3 month follow-up interval. Treatment with sCT resulted in a pronounced suppression of bone resorption markers with a maximum effect reached after 8 weeks of therapy: as compared to the respective baseline values, mean levels decreased by -26.2% +/- 3.4% (P < 0.001) for pyridinoline, -32.7% +/- 3.5% (P < 0.001) for deoxypyridinoline, -32.7% +/- 3.3% (P < 0.001) for hydroxyproline, and -24.1% +/- 8.2% (P < 0.001) for the amino-terminal telopeptide. In contrast, changes in bone formation markers of osteocalcin (-14.4% +/- 4.8%, P < 0.05) and C-terminal procollagen type I propetide (-7.9% +/- 3.9%, ns) were much less pronounced. Unexpectedly, after week 8 of the study all resorption markers showed a plateau and a trend to increase, although intranasal sCT was continued for a total of 12 weeks. This effect could not be attributed to the formation of anti-sCT antibodies. After cessation of treatment, both bone formation and resorption markers rapidly returned to baseline levels. Bone mineral density of both spine and hip showed no significant change during the observation period. Our results demonstrate that in postmenopausal women with a high bone turnover, intranasal treatment with 200 IU of sCT effectively reduces bone turnover and maintains bone mass, the maximum effect being reached after 8 weeks of treatment.

Clinical application of immunoassay for urinary total excretion of deoxypyridinoline in patients with osteoporosis

“…Intermittent intramuscular administration of low doses of calcitonin (10 IU twice a week or 20 IU once a week) is approved and prescribed for osteoporosis in Japan [23]. In contrast, higher intramuscular doses [24] and intranasal administration of calcitonin [25,26], treatment protocols ordinarily used for clinical studies outside Japan, have also failed to show significant effects on markers for bone resorption.…”

The Analgesic Role of Calcitonin Following Osteoporotic Fracture

“…Firstly, SCT has been shown to provide pain relief in a wide variety of conditions, not only those in which an antiresorptive effect may be the mechanism, such as Paget's disease [71][72][73][74], rheumatoid arthritis [75,76] and metastatic cancer [77][78][79][80][81][82], but also in other conditions, for example, reflex sympathetic dystrophy [83,84], phantom pain [85] and migraine [86,87]. Secondly, significant analgesia occurs within days of initiating SCT treatment, well before the maximum effect on bone markers is reached at 8 weeks [88]. Support for a central analgesic effect, as suggested by preclinical evidence, has come from a study in which subarachnoid injection of SCT induced long-lasting analgesia in human subjects [89].…”

Prescrition Drug Therapies

“…There is evidence of a plateau in the effect of calcitonin salmon on markers of bone resorption after 8 weeks of treatment, suggesting that intermittent administration may be appropriate. 49 Further study is needed. An analgesic effect from intranasal calcitonin salmon has been reported in patients with osteoporotic vertebral fractures.…”