Calcitonin
/ 32-amino-acid peptide hormone; calcitonin receptor agonist; salmon-derived form is most clinically usedALIAS · Salmon calcitonin · Miacalcin · Fortical
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FDA-approved for Paget disease of bone, hypercalcemia of malignancy, and postmenopausal osteoporosis. Long clinical history; usage has declined as bisphosphonates and denosumab became first-line.
Calcitonin is a 32-amino-acid peptide secreted by thyroid parafollicular C cells that opposes parathyroid hormone and suppresses osteoclast activity. The salmon form (Miacalcin, Fortical) has approximately 50-fold higher potency than human calcitonin at the human calcitonin receptor and is the clinically used species.
Established in clinical use since the 1970s-80s. Intranasal and subcutaneous formulations have been used for osteoporosis and analgesic effects in vertebral fracture. Modern osteoporosis practice has largely shifted to bisphosphonates, denosumab, and teriparatide.
Nasal calcitonin most common AEs: rhinitis, epistaxis. EMA 2012 safety review found a small increased malignancy signal with long-term use, leading to restriction of intranasal calcitonin in Europe. Subcutaneous formulations retained broader labeling.
Regulatory status
- FDA status:
- FDA-approved
- Compounding:
- Not eligible for compounding (approved, not in shortage)
The 2012 EMA malignancy signal prompted restricted European labeling on chronic nasal calcitonin use for osteoporosis. US labeling retained the indication but with updated warnings. Clinical use has declined as better-tolerated alternatives with stronger fracture-reduction data have emerged.