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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Calcitonin Salmon/ Calcimar / Miacalcin Nasal Spray



- Dosing:
    - contraindicated w/ clinical allergy, must periodically examine urine sediment with chronic use;
    - for symptomatic Paget's Disease of bone, hypercalcemia, post-menopausal osteoporosis (in addition to supplemental calcium, adequate vitamin D intake, and adequate diet);
    - osteoporosis:
            - may be indicated for the female w/ osteoporosis in whom estrogen is contraindicated (such as thrombophlebitis);
            - if pt is unable to take estrogen, calcitonin therapy at dose of 50-200 units per day, injected subcutaneously, can be prescribed;
            - inhibits on going bone resorption;
            - osteoporosis: 100-200 IU/day, in nasal spray form this is one puff per day alteranating nostrils;
            - this agent is safe for patients who have sustained osteoporotic compression fractures, and even has some anesthetic qualities;
            - this agent requires calcium intake for optimal effect;
            - patients may expect increases in the lumbar spine density of about 3 % per 2 years;
    - Paget's disease:
            - calcitonin does have proven pharacological value and is used to treat Paget's disease, prevent disuse osteoporosis, & lower serum calcium in severe hypercalcemic states;
            - it appears to have a prophylactic role in Osteoporosis;
            - even in Pagetic pts, beneficial effects of calcitonin may eventually be lost with continued treatment;
            - calcitonin, in pharmacologic doses, reduces osteoclastic action and has proven effective for Pagets disease;
            - dose: 100-200 IU/day, in nasal spray form this is one puff per day alteranating nostrils;
    - hypercalcemia:
            - calcitonin may be used in hypercalcemia, but it is relatively short-acting, lasting only 48-72 hrs;
            - when hypercalcemia is severe & need to lower serum Ca concentration is urgent, calcitonin will induce most rapid, decrease in serum calcium level;
            - hypercalcemia: 4 IU/kg q12hr SC/IM initially;
            - may increase dosage to 8 IU/kg q12hr SC/IM, after 24-48hr if response is unsatisfactory;
            - if response still remains unsatisfactory, may increase dose to 8 IU/kg SC/IM q6hr p 2 more days;


- Discussion and Mechanism of Action:
    - calcitonin is potent inhibitor of osteoclastic bone resorption;
    - in bone, major action is inhibition of osteoclastic bone resorption;
          - calcitonin inhibits bone resorption and slows down  rate of bone loss;
          - osteoclasts escape from the inhibitory effects of calcitonin following continued exposure;
    - post frx pain:
          - calcitonin has inherent analgesic properties, and may be useful in the early post fracture period;
    - major side effect is flushing and nausea;
    - these side effects are dose dependent;
    - recommended dose is 100 units SQ qd but few patients will tolerate this dose initially;
    - consider starting with 25 units three times a week;
    - calcitonin circulates in the blood of humans of all ages, but no pathology can be attributed to its absence or excess.
    - teleologic function of calcitonin:
            - it acts as an antihypercalcemic agent, however, when challenged w/ hypercalcemia is present, its protective action is overridden;
            - its presence postprandially maintains parathyroid secretion at a time when it would normally be reduced by calcium entering the blood from the digestive tract;
            - through this action, it indirectly (by way of parathyroid hormone) reduced postprandial renal calcium excretion;
            - it directs additional calcium into bone, possibly into temporary storage for return to blood during intermeal fasting periods



New modes of administration of salmon calcitonin in Paget's disease. Nasal spray and suppository.

Calcitonin and the peptides from the calcitonin gene.

High calcitonin levels in unconscious polytrauma patients.

Intranasal and intramuscular human calcitonin in female osteoporosis and in Paget's disease of bones: a pilot study.

Vitamin D status in Paget's bone disease. Effects of calcitonin therapy.

Osteotomy for tibia vara in Paget's disease under cover of calcitonin.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 22, 2012 2:39 pm