Calcitonin adverse effects

Disease-induced, dmg-induced, old age-induced, immobility-induced and menopause-induced osteoporosis is all relatively cheap to prevent but become very expensive and difficult to treat as soon as a fractures occur. Oral calcium, vitamin D, biphos-phonates, hormone replacement and parenteral calcitonin in post-menopausal women, achieved annual BMD increases of 0.5-1.5%. Limited efficacy of less than 0.5% annual BMD increase, adverse effects, and high costs have restricted the large scale use of calcitonin. 

Salmon- and eel-derived calcitonins are more potent than the human and porcine forms. Intranasal calcitonin has a systemic availability of only 3% of the subcutaneous form but is associated with fewer adverse effects, probably because of lower systemic availability. Antibodies against calcitonin are often found after prolonged treatment, more commonly with salmon (30-69%) or eel calcitonin than with human calcitonin. Antibodies do not usually affect the clinical effect of calcitonin and have not been reported to cause any harm to the patient. Antibody-mediated resistance is exceptional. 

Intranasal calcitonin is associated with fewer adverse effects than parenteral formulations, probably because of low systemic availability. However, a meta-analysis has confirmed that adverse events are poorly reported in clinical trials (21). The pooled relative risk for rhinitis from four trials (n = 1663) was 1.72, but this did not reach statistical significance. 

The adverse effects of parenteral and intranasal calcitonin have been compared (22). Parenteral salmon calcitonin is commonly associated with flushing of the face, ears, hands, and feet within minutes of the injection. Nausea and vomiting can occur within 30 minutes. The flushing needs to be distinguished from the less common but serious and potentially fatal hypersensitivity reactions that have been reported. The nausea, which is mild, usually abates with continued therapy. Intranasal calcitonin is better tolerated rhinitis of mild or moderate severity is the most frequent adverse effect. 

A 65-year-old woman, who had previously tolerated calcitonin nasal spray, developed eye and nose congestion, an itchy nose, and sneezing minutes after using intranasal salmon calcitonin (17). She was later given intramuscular salmon calcitonin and developed generalized urticaria and nasal itching within minutes. Skin testing was positive with eel and salmon calcitonins but not human calcitonin, and she was treated with human calcitonin without adverse effects. 

Administration. The intranasal dose of calcitonin is sprayed in alternating nares every other day (see Table 88-6). Other than minor nasal adverse effects, calcitonin is well tolerated. Subcutaneous administration at 100 units daily is available but rarely used. 

An increase in trabecular bone mass by as much as 50% has been demonstrated in patients treated with low doses of PTH, but it comes at the expense of the cortical bone (1,11,25). Treatment with high doses of PTH is correlated with stimulation of bone resorption (20). Cyclical therapy with PTH and calcitonin has been shown to improve BMD in the spine without adverse effects in the cortical bone (11). When given in combination with estrogen, PTH promoted the formation of well-mineralized trabecular bone. 

The adverse effects of salmon calcitonin have again been reviewed [1 ]. Salmon calcitonin nasal spray is thought to be safe. Hypersensitivity is the only contraindication. The systemic adverse reactions of flushing and nausea that occur with injections are rare. Loccd reactions due to nasal irritation are the most common adverse reactions. 

Reviews A review of antiresorptive therapies for osteoporosis identified the following as the most commonly reported adverse effects of calcitonin therapy irritation of the nasal passage nasal mucosal erythema and minor bleeding sneezing rhinitis and nausea [3 ]. Across studies these side effects generally occurred in less than 10% of patients receiving calcitonin treatment. 

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