Peptide

Salmon calcitonin

Hormone that slows bone breakdown. Today its use is limited to Paget's disease, hypercalcemia, and acute bone loss from immobilization, because of a small increase in cancer risk.

Regulatory status

Approved (FDA / EMA)

Family

Calcitonin hormone (salmon)

Scientific evidence

Moderate

Number of findings

Where it acts

Bones and muscles · Hormones and metabolism

Also known as

calcitonin-salmon, calcitonin, Miacalcin, Fortical, salcatonin

Regulatory status

FDA (US): Approved (injectable since 1975, Miacalcin; nasal spray since 1995) for Paget's disease, hypercalcemia, and postmenopausal osteoporosis when other drugs cannot be used; with a cancer risk warning.

EMA (EU): Authorized nationally (no centralized authorization). In 2012 the EMA limited its use to the injectable and to the short term because of an increased cancer risk, and withdrew the nasal spray for osteoporosis.

Dose

Paget's: 100 IU/day subcutaneously or intramuscularly; hypercalcemia: 4 IU/kg every 12 hours, adjustable (FDA Miacalcin label). In the EU, treatments as short as possible: immobilization 2–4 weeks, Paget's normally up to 3 months (EMA 2012).

Safety

Nausea, facial flushing, local reactions; the nasal spray causes rhinitis. Possible allergic reactions. In long trials the cancer risk was 0.7–2.4% higher than with placebo, so it is not recommended long term. May lower calcium too much. Only with a prescription.

Interactions

May require adjusting lithium (lowers its levels). Caution with other drugs that lower calcium.

Effect by goal · level of evidence

Vertebral fractures in postmenopausal osteoporosis

reduces Low-moderate RCT (AA) in people

−33% vertebral fractures (200 IU only)

5-year PROOF trial with 1,255 women: the 200 IU/day nasal spray reduced new vertebral fractures by 33%, but 100 and 400 IU did not. Bone density rose only 1–1.5%.

View the study (RCT) →

In depth

Where it acts

Bones and muscles, Hormones and metabolism

How it works

It binds to receptors on osteoclasts, the cells that break down bone, and slows them. This lowers blood calcium and reduces bone loss. Salmon calcitonin is more potent and longer-lasting than the human form.

What the evidence says

In people

Vertebral fractures in postmenopausal osteoporosis. 5-year PROOF trial with 1,255 women: the 200 IU/day nasal spray reduced new vertebral fractures by 33%, but 100 and 400 IU did not. Bone density rose only 1–1.5%. PubMed 10996576

References

PubMed 10996576

Information, not medical advice. Prescription or unapproved peptides should only be used under medical supervision.