Teriparatide
The first bone-building osteoporosis drug, approved since 2002. Reduces vertebral fracture substantially and is one of the best-characterised anabolic agents in medicine.
Bone & Muscle
Calcitonin
An approved hormone therapy for hypercalcaemia, Paget's disease and osteoporosis. Its osteoporosis use has narrowed sharply over a cancer signal in long-term data.
Overview
Calcitonin is released by the thyroid when blood calcium runs high, and it tells the cells that dissolve bone to stop. The version used clinically comes from salmon, which binds the human receptor far more strongly than the human hormone does. It lowers calcium quickly, which is useful in an emergency, and it has a genuine analgesic effect in acute vertebral fracture. Its role in ordinary osteoporosis treatment has largely been withdrawn.
A 32-amino-acid peptide hormone from thyroid parafollicular C cells. Salmon calcitonin has roughly 40-fold higher affinity for the human calcitonin receptor and a longer half-life than the human sequence. Acts on osteoclast calcitonin receptors, causing rapid cytoskeletal retraction and loss of the ruffled border, halting resorption within minutes. Renal effects increase calcium and phosphate excretion. Nasal calcitonin's osteoporosis indication was withdrawn in the EU and restricted by the FDA after a meta-analysis of long-term trials found a higher rate of malignancy in treated groups.
Research areas
OsteoporosisHypercalcaemiaPaget's diseaseFracture pain
Dosing reported in the literature
Every protocol below is reproduced from a published study or approved labelling, with its source named. These are records of what was studied — not recommendations, and not a suggestion that any of them is appropriate for any person.
| Protocol as reported | Source |
|---|---|
| 200 IU intranasally once daily, alternating nostrils | Approved product labelling |
| 4 IU/kg subcutaneously or intramuscularly every 12 hours in hypercalcaemia, escalating to 8 IU/kg every 6–12 hoursTachyphylaxis develops within 48–72 hours, so it is a bridge to slower-acting therapy, not a treatment on its own. | Approved product labelling |
Trial status
Long clinical history including the PROOF fracture trial; subsequent meta-analysis raised the malignancy signal that changed its regulatory status.
Reported safety signals
- A meta-analysis of long-term trials found a higher overall malignancy rate in calcitonin-treated participants, which led the EMA to withdraw the osteoporosis indication.
- Nasal irritation and epistaxis are common with the spray.
- Tachyphylaxis limits usefulness in hypercalcaemia to the first couple of days.
- Hypersensitivity reactions, including rare anaphylaxis, have been reported with the salmon-derived peptide.
Common questions
Why is calcitonin related to the amylin peptides?
Amylin receptors are the calcitonin receptor paired with accessory proteins called RAMPs. That is why cagrilintide and other amylin analogues have calcitonin receptor activity, and why the two families keep appearing in the same discussions.
Primary sources
Medical disclaimer
This page is for informational and research purposes only. Nothing here constitutes medical advice. The compounds discussed are research chemicals. Consult a qualified clinician before starting any protocol.
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