Uses of calcitonin: The therapeutic uses of calcitonin
Calcitonin – Side Effects, Uses, Dosage, Overdose, Pregnancy, Alcohol
Reviewed: August 27, 2012
Calcitonin is a prescription medication used for the treatment of osteoporosis in women more than 5 years after menopause (end of monthly menstrual periods) who cannot or do not want to take estrogen products. Calcitonin is a man-made version of calcitonin, a hormone that regulates bone formation and breakdown.
Calcitonin comes in two forms, a nasal spray and an injectable form. This medication guide focuses on the nasal spray. It is usually sprayed once in alternating nostrils each day.
Common side effects of calcitonin nasal spray include runny nose, back or joint pain, and headaches.
Calcitonin is a prescription medication used for the treatment of osteoporosis in women more than 5 years after menopause (end of monthly menstrual periods) who cannot or do not want to take estrogen products. It is used along with calcium and vitamin D.
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.
Calcitonin may be found in some form under the following brand names:
Side Effects of Calcitonin
Most patients tolerate treatment with calcitonin very well; however, like all prescription drugs, calcitonin may cause some side effects in some people. These side effects are usually mild and generally do not lead to discontinuation of treatment with calcitonin. The most commonly reported side effects are:
- Nasal symptoms such as runny nose, crusting, or nasal bleeding
- Back/joint pain
Anytime you have a medical problem you think may be related to calcitonin, talk to your doctor or healthcare provider.
No calcitonin interactions have been identified, however, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.
Calcitonin should not be used by patients who are allergic to the protein calcitonin-salmon, or by women who are pregnant or nursing.
You should be aware of these warnings and precautions when taking calcitonin.
- No formal studies designed to test drug interactions with calcitonin-salmon have been done; however, no drug interactions have been observed with the use of calcitonin. You should inform your doctor and pharmacist about the other prescription and nonprescription medications you are taking.
- In clinical studies, nasal symptoms occurred in approximately 9% of postmenopausal patients taking calcitonin. For this reason, it is recommended that a nasal examination be performed prior to the start of treatment and at any time nasal complaints occur.
- Rare instances of nasal ulceration have occurred with calcitonin. In some cases, your doctor may decide to temporarily discontinue treatment with calcitonin until symptoms subside.
- Because calcitonin-salmon is a protein, the possibility of a systemic allergic reaction exists. Patients who are allergic to calcitonin-salmon should not use calcitonin.
- Calcitonin is safe to use in elderly patients. A slight increase in nasal symptoms has been observed in patients over 65 years of age, however the symptoms are usually mild. No other unusual side effects have been seen in patients over 65 years of age.
Calcitonin Food Interactions
Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of calcitonin there are no specific foods that you must exclude from your diet when receiving calcitonin.
Tell your healthcare provider about all of your medical conditions including if:
- you are pregnant or breastfeeding
- you are allergic to calcitonin or any other medicine
- you have low blood calcium (hypocalcemia)
Tell your healthcare provider about all of the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Calcitonin has not been studied in pregnant women and may not be safe for use during pregnancy. This medication is not approved for women who are premenopausal, including pregnant women. Tell your healthcare provider if you are pregnant or plan to become pregnant.
Calcitonin is not approved for premenopausal women, including women who are breastfeeding. It is not known if calcitonin is excreted in human breast milk or if it will harm your nursing baby.
The recommended dose of calcitonin is one spray daily in alternated nostrils, unless directed otherwise by your healthcare provider. Start with a spray in the left nostril on your first day, followed by a spray in the right nostril on the second day. Continue to alternate nostrils every day. There are at least 30 “doses” of calcitonin in each bottle.
You should keep track of the number of doses used from the bottle.
After 30 doses, each spray may not deliver the correct amount of medication, even if the bottle is not completely empty.
When taking calcitonin, it is recommended that you get at least 1000 mg of calcium and 400 I.U. (International Units) of vitamin D each day. Check with your doctor or healthcare provider to see if you are getting enough calcium and vitamin D in your diet. If not, he or she may recommend that you start taking calcium and vitamin D supplements.
A single spray contains one daily dose, which is 200 I.U. of calcitonin-salmon. The fine mist is actually 0.09 mL (milliliter) of solution. Your bottle of calcitonin nasal spray contains at least 30 doses. Priming the pump does not alter the total number of doses available in a bottle of calcitonin nasal spray. The bottle need only be primed once after assembly. Do not re-prime or “test spray” your bottle before you use your daily dose of calcitonin nasal spray. This will waste your medication.
If you take too much calcitonin, call your local Poison Control Center or seek emergency medical attention right away. Symptoms of overdose include:
- muscle twitches
- irregular heart rhythm
Important Facts About calcitonin nasal spray:
- The bottle contains the proper amount of medication. Be aware that the entire bottle will not be filled with liquid.
- Before opening and assembling your medication bottle, keep it in your refrigerator between 2°C-8°C (36°F-46°F). Do not freeze.
- After opening and assembling a new medication bottle, keep it at room temperature between 15°C-30°C (59°F-86°F) in an upright position.
- Do not refrigerate the unit between doses.
- Do not store the unit on its side.
- Bottles left at room temperature (opened or unopened) for more than 35 days must be discarded.
- Refrigerated bottles are good until the expiration date stamped on the bottle and box.
Calcitonin Salmon – Injection | HealthLink BC
Common Brand Name(s): Calcimar , Caltine
Important: How To Use This Information
This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
This medication is used to treat certain bone problems (e.g., Paget’s disease, postmenopausal osteoporosis) and to reduce high blood levels of calcium. Calcitonin is a man-made hormone that works by slowing bone loss and maintaining normal calcium levels in the blood. It may also help to reduce bone pain in people who have Paget’s disease.
How To Use
This medication is given by injection under the skin or into a muscle. For the treatment of high calcium, you will usually use this medication every 12 hours. For the treatment of osteoporosis, you will usually use this medication every other day. For the treatment of Paget’s disease, you will usually use this medication daily to every other day or as directed by your doctor. If you are using more than 2 milliliters of the medication at a time, it is recommended that you inject the medication into a muscle. Use this medication exactly as prescribed by your doctor. Learn all preparation and usage instructions in the product package. If you have questions about the use of this medication, consult your doctor or pharmacist.
The dosage is based on your medical condition and response to treatment. For the treatment of high calcium, the dosage is also based on weight. It is recommended to use this medication at the lowest effective dosage and for the shortest possible duration to treat your condition. Patients treated long-term with this medication have shown a rare risk of developing cancer. Discuss with your doctor the benefits and risks of long term treatment with this medication.
Before injecting each dose, check this product visually for particles or discoloration. If either is present, do not use the liquid. Also, clean the injection site with rubbing alcohol before injecting. It is important to change the location of the injection site each time to avoid problem areas under the skin or in the muscle.
Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day. If you are using this medication on a schedule other than every day (e.g., every other day), it may help to mark your calendar with a reminder.
Learn how to store and discard needles and medical supplies safely. Consult your pharmacist.
Tell your doctor if your condition persists or worsens.
(See also How to Use section).
Nausea, abdominal pain, diarrhea, vomiting, or flushing may occur. Using this medication at bedtime may help to decrease these side effects. Swelling/redness at injection site, a salty taste in mouth, increased urination, or loss of appetite may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including:
- eye pain
- swelling ankles/feet
- muscle cramps/spasms
- numbness/tingling of the arms/legs
Get medical help right away if you have any very serious side effects, including:
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:
- itching/swelling (especially of the face/tongue/throat)
- severe dizziness
- trouble breathing
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US –
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Before using this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of:
- low level of calcium in the blood
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
A product that may interact with this drug is:
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: nausea, vomiting.
Do not share this medication with others.
Lifestyle changes that help promote healthy bones include increasing weight-bearing exercise, stopping smoking, limiting alcohol, and eating well-balanced meals that contain adequate calcium and vitamin D. Since you may also need to take calcium and vitamin D supplements and make lifestyle changes, consult your doctor for specific advice.
Depending on the condition that you are treating, laboratory and/or medical tests (e.g., urine sediment, bone mineral density, calcium levels) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.
Store in the refrigerator. Do not freeze. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Calcitonin nasal spray
What is this medicine?
CALCITONIN (kal si TOE nin) stops bone loss and breaks. It will make your bones more dense, or thicker. This medicine is used to treat postmenopausal osteoporosis.
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.
COMMON BRAND NAME(S): Fortical, Miacalcin
What should I tell my health care provider before I take this medicine?
They need to know if you have any of these conditions:
- nasal sores or trauma
- an unusual or allergic reaction to calcitonin, fish, other medicines, foods, dyes, or preservatives
- pregnant or trying to get pregnant
How should I use this medicine?
This medicine is only for use in the nose. Do not take by mouth. Follow the directions on your prescription label. Alternate nostrils daily. Do not use more often than directed. Make sure that you are using your nasal spray correctly. Ask you doctor or health care provider if you have any questions.
Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.
What if I miss a dose?
If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.
What may interact with this medicine?
- prior bone scan with diphosphonate in patient with Paget’s disease
This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.
What should I watch for while using this medicine?
Visit your doctor or health care professional for regular checks on your progress. Your doctor will need to exam the inside of your nose before you start using the medicine and periodically during use.
Talk to your doctor about your risk of cancer. You may be more at risk for certain types of cancers if you take this medicine.
Be sure that you get at least 1000 mg of calcium and 400 I.U. of vitamin D while you are taking this medicine. This will help the medicine work better. Ask your doctor or health care provider for good nutrition advice.
What side effects may I notice from receiving this medicine?
Side effects that you should report to your doctor or health care professional as soon as possible:
- allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
- breathing problems
- chest pain, tightness
- infection or fever
- nosebleed or nose sores
- tingling in the hands or feet
Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
- back or joint pain
- nausea or upset stomach
- runny, stuffy, or irritated nose
- watery eyes
This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Where should I keep my medicine?
Keep out of the reach of children.
Store the unopened medicine in a refrigerator between 2 and 8 degrees C (36 and 46 degrees F). Do not freeze. Once opened store at room temperature between 15 and 30 degrees C (59 and 86 degrees F) in an upright position for up to 35 days. Throw away any unused medicine after the expiration date.
NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.
You and Your Hormones from the Society for Endocrinology
Alternative names for calcitonin
What is calcitonin?
Calcitonin is a hormone that is produced in humans by the parafollicular cells (commonly known as C-cells) of the thyroid gland’ data-content=’1456′ >thyroid gland. Calcitonin is involved in helping to regulate levels of calcium and phosphate in the blood, opposing the action of parathyroid hormone. This means that it acts to reduce calcium levels in the blood. However, the importance of this role in humans is unclear, as patients who have very low or very high levels of calcitonin show no adverse effects.
Calcitonin reduces calcium levels in the blood by two main mechanisms:
- It inhibits the activity of osteoclasts, which are the cells responsible for breaking down bone. When bone is broken down, the calcium contained in the bone is released into the bloodstream. Therefore, the inhibition of the osteoclasts by calcitonin directly reduces the amount of calcium released into the blood. However, this inhibition has been shown to be short-lived.
- It can also decrease the resorption of calcium in the kidneys, again leading to lower blood calcium levels.
Manufactured forms of calcitonin have, in the past, been given to treat Paget’s disease of bone and sometimes hypercalcaemia and bone pain. However, with the introduction of newer drugs, such as bisphosphonates, their use is now very limited.
How is calcitonin controlled?
The secretion of both calcitonin and parathyroid hormone is determined by the level of calcium in the blood. When levels of calcium in the blood increase, calcitonin is secreted in higher quantities. When levels of calcium in the blood decrease, this causes the amount of calcitonin secreted to decrease too.
The secretion of calcitonin is also inhibited by the hormone somatostatin, which can also be released by the C-cells in the thyroid gland.
What happens if I have too much calcitonin?
There does not seem to be any direct deleterious effect on the body as a result of having too much calcitonin.
Medullary thyroid cancer is a rare type of cancer that arises from the C-cells in the thyroid gland that secrete calcitonin. It is sometimes associated with multiple endocrine neoplasia type 2a and multiple endocrine neoplasia type 2b. Patients with medullary thyroid cancer have high calcitonin levels in their bloodstream. However, it is important to note that these high calcitonin levels are a consequence of this condition, not a direct causal factor.
What happens if I have too little calcitonin?
There does not seem to be any clinical effect on the body as a result of having too little calcitonin. Patients who have had their thyroid gland removed, and have undetectable levels of calcitonin in their blood, show no adverse symptoms or signs as a result of this.
Last reviewed: Feb 2018
Calcitonin (Miacalcin) Uses & Side Effects
Calcitonin is a hormone that lowers calcium levels in the blood. It can be used orally, via nasal spray or via injections for osteoporosis, Paget’s disease, and hypercalcemia (elevated calcium levels). Read more about the uses and side effects of calcitonin.
Disclaimer: Calcitonin is a prescription medication that should only be used by a doctor’s prescription. By writing this post, we are not recommending the use of calcitonin. This post provides an overview of the scientific literature on this drug. Speak with your doctor about your medications and call your doctor for medical advice about side effects.
What Is Calcitonin?
Benefits and Drawbacks of Calcitonin (Miacalcin)
Calcitonin is a peptide hormone produced in the thyroid gland by parafollicular cells (also called C-cells). It is produced from procalcitonin, a larger peptide, that is in turn controlled by the calcitonin gene (CALCA). Calcitonin helps maintain calcium blood levels. If calcium levels are too high, then this hormone reduces them .
The hormone is produced in response to:
- High calcium levels in the blood .
- Gastrin, a peptide hormone produced in the stomach, which triggers the release of stomach acid to digest food .
Scientists consider calcitonin has the following function:
- Reducing osteoclast activity and bone loss. Osteoclasts are bone cells that break down bone tissue. This releases calcium into the bloodstream. By preventing osteoclast activity, calcitonin preserves bone density and decreases the levels of calcium in the blood [1, 4, 5].
- Decreasing the reuptake of calcium in the kidneys, hence increasing the elimination of calcium through the urine .
Calcitonin produces effects by binding to the calcitonin receptor (CALCR) found in the bones, in the kidney, and regions of the brain .
Calcitonin is used to treat osteoporosis in postmenopausal women, Paget’s disease of bone, and hypercalcemia (elevated calcium levels). Research suggests that calcitonin may reduce the risk of fractures, however, its fracture reduction efficacy has not been demonstrated in large-scale studies [4, 8, 9].
In general, a normal calcitonin value is less than 10 pg/mL.
Women have lower calcitonin levels than men, due to lower production [10, 2].
Levels in women increase in pregnancy and breastfeeding [11, 10].
In postmenopausal women on estrogen treatment, levels may be higher [12, 2].
Adults have lower levels than infants and children [13, 14, 2].
Depending on age and gender, the following normal levels of calcitonin have been proposed :
- <40 pg/L in children under 6 months of age
- <15 pg/L in children between 6 months and 3 years of age
- <5 pg/L for women (adults)
- <12 pg/L for men (adults)
Levels may slightly differ between laboratories.
Levels may also decrease with age and increase in chronic kidney disease, although the mechanism is still unclear .
Interestingly, some people with very low (removal of the thyroid) or very high calcitonin levels show no adverse effects related to calcium balance and have no other medical issues [11, 16].
Lab results are commonly shown as a set of values known as a “reference range”, which is sometimes referred to as a “normal range”. A reference range includes the upper and lower limits of a lab test based on a group of otherwise healthy people.
Your healthcare provider will compare your lab test results with reference values to see if any of your results fall outside the range of expected values. By doing so, you and your healthcare provider can gain clues to help identify possible conditions or diseases.
Remember that some lab-to-lab variability occurs due to differences in equipment, techniques, and chemicals used. Don’t panic if your result is slightly out of range – as long as it’s in the normal range based on the laboratory that did the testing, your value is normal.
However, it’s important to remember that a normal test doesn’t mean a particular medical condition is absent. Your doctor will interpret your results in conjunction with your medical history and other test results.
But remember that a single test isn’t enough to make a diagnosis. Your doctor will interpret this test, taking into account your medical history and other tests. A result that is slightly low/high may not be of medical significance, as this test often varies from day to day and from person to person.
High Levels & Thyroid Cancer
Elevated levels of calcitonin may indicate thyroid cancer (medullary cancer of the thyroid), the most common cause of high blood calcitonin .
However, high levels can also be due to:
- Lung cancer
- Kidney disease
- Drugs for acid reflux
Speak to your doctor if your calcitonin levels are high. He or she will ensure you get an accurate diagnosis and treatment.
Medullary thyroid carcinoma is a form of thyroid cancer that originates from thyroid C-cells, which produce calcitonin. This cancer triggers the production of calcitonin [17, 18].
According to some studies, levels higher than 60 pg/ml can indicate medullary thyroid carcinoma, whereas if the levels are between the cutoff range and 60 pg/ml, it could indicate C-cell hyperplasia (a genetic defect of the thyroid gland) .
In a clinical trial of 54 patients who were surgically treated for medullary thyroid carcinoma, those with calcitonin levels higher than 1 ng/ml (measured within 1 month after surgery) had a higher risk of cancer reappearing compared to those with lower levels .
Levels greater than 2 ng/ml after surgery were associated with lower cancer survival rate. However, levels measured before the surgery had no predictive effect on survival or disease recurrence .
Injections, tablets, or nasal spray, have been used to treat several conditions.
1) Osteoporosis in Postmenopausal Women
Calcitonin is indicated for treating osteoporosis in postmenopausal women when alternative treatments (estrogen products) are not suitable [21, 22, 23].
It is also safe to use in postmenopausal women who have both osteoporosis and chronic asthma .
In a clinical study (DB-RCT) of 1,255 postmenopausal women with osteoporosis, calcitonin nasal spray lowered the risk of spinal fractures compared to placebo, while increasing spine bone density .
In a study (DB-RCT) of 28 men with osteoporosis, calcitonin nasal spray increased bone density by 7% and decreased bone turnover more effectively than the placebo .
Clinical trials have shown that calcitonin maintains the bone mass in the lower back (but not in the femoral neck) by 3% higher compared to placebo. Its protective effect against bone mass loss was higher when patients received corticosteroids for more than 3 months .
Similarly, calcitonin nasal spray prevented bone loss in the lower back and resulted in a 1% decrease in bone density compared to 5% with placebo .
In a study (DB-RCT) of 90 healthy women, nasal calcitonin prevented the deterioration of the bones in the lower leg (tibia) and forearm (distal radius) .
However, its ability to reduce fracture risk has not been demonstrated. In a study (DB-RCT) of 4,665 postmenopausal women with osteoporosis showed that calcitonin did not prevent spinal or non-spinal fractures [23, 30].
Acute Pain in Osteoporosis
According to the evidence, calcitonin relieves acute but not chronic pain in osteoporosis. In a systematic review including 774 patients with osteoporosis, this hormone significantly reduced pain and/or improved daily function .
In another systematic review including 246 patients with osteoporosis, calcitonin therapy effectively reduced acute pain (in all functions including resting, sitting, standing, and walking) within one week after treatment .
A meta-analysis including 589 patients with spinal bone fractures due to osteoporosis showed that calcitonin relieved the acute pain of recent fractures but had no effect on chronic pain and older fractures .
Similarly, in 110 women with osteoporosis, calcitonin nasal spray did not have any effect on chronic pain and daily activities, irrespective of previous fractures or non-specific back pain .
Scientists hypothesize calcitonin may block pain in osteoporosis by [35, 36]:
- Decreasing serotonin transporters (SLC6A4), but increasing serotonin receptors (HTR1A).
- Altering the sodium channel transcription, which controls the excitability of nerves.
2) Paget’s Disease of Bone
Calcitonin is indicated for treating symptomatic Paget’s disease of bone when alternative treatments are not suitable .
Paget’s disease is a chronic condition that causes over-the-top breakdown and formation of bone tissue, which results in large, deformed, weak bones, and pain. It is common among older people and affects one or more bones .
In patients with Paget’s disease, the levels of the protein alkaline phosphatase are elevated and indicate the severity of the disease. Calcitonin reduces the activity of alkaline phosphatase, relieves bone pain, and increases bone blood vessels, which is vital for bone formation .
In a clinical study of 18 patients with Paget’s disease, both calcitonin nasal spray and injections lowered alkaline phosphatase levels .
Calcitonin is indicated for the treatment of hypercalcemia (elevated blood calcium levels). It has been used for this indication for many years [23, 40, 2].
In a randomized study of 40 patients, calcitonin injections effectively treated hypercalcemia within first 24 hours of treatment .
In 12 patients with acute hypercalcemia, this hormone reduced calcium levels and improved their clinical condition. However, it was less effective for malignant conditions .
Calcitonin lowers blood calcium levels by preventing bone-resorbing osteoclasts (bone cells) that release calcium from bones into the blood and by increasing calcium loss through the urine. Its effects can be seen within the first 6 hours of dosing .
For treatment of hypercalcemia (elevated calcium levels), it should be administered via injections as the nasal spray is not effective. Calcitonin serves as the first line of treatment .
Possibly Effective for:
Acute Phantom Limb Pain
People missing a limb, usually after an amputation, often experience pain where the limb used to be, a phenomenon known as “phantom limb pain” .
Limited research points to calcitonin as a potentially promising therapy, though the evidence is mixed. Large-scale studies are needed before the safety and efficacy of calcitonin in people with acute phantom limb pain is determined.
In a study (DB-RCT) of 21 patients with major amputations, a week after the first calcitonin treatment, 90% of the patients reported that their pain decreased by 50% or more, 76% of the patients were pain-free, and 71% of the patients never reported phantom limb pain again. A year later with calcitonin treatment, 8 out of the 13 surviving patients reported more than 75% pain relief .
A small clinical trial of 10 people with phantom limb pain showed that in 9 of them calcitonin immediately relieved pain symptoms .
On the contrary, a trial (DB-RCT) of 20 patients with chronic phantom limb pain showed that ketamine and not calcitonin was effective in pain relief and the combination of ketamine and calcitonin was less effective than ketamine alone .
Thus, calcitonin is likely not effective for chronic phantom limb pain.
Total Hip Replacement Pain
In an open clinical trial of 37 middle-aged women who had undergone total hip replacement, calcitonin nasal spray together with calcium and vitamin D supplements resulted in less dependence on assistance from others and less fear of falls. Furthermore, calcitonin decreased further bone density loss, relieved pain, and accelerated the repair of hip fractures .
Similar results were seen in a clinical study of 75 women after their total hip replacement, as calcitonin nasal spray significantly decreased pain, bone density loss, and bone turnover. It also decreased the risk of falls and fractures and accelerated hip repair .
Further clinical trials are needed to establish the safety and efficacy of calcitonin for total hip replacement pain.
Likely Ineffective for:
Lumbar Spinal Stenosis
Lumbar spinal stenosis is a chronic disease which causes narrowing of the spinal canal in the lower back, known as the lumbar area by an overgrown bone or bone tissue .
A meta-analysis concluded that calcitonin is not effective in increasing the walking distance or relieving the pain among patients with lumbar spinal stenosis .
Six more clinical trials showed that calcitonin injections were not more effective in pain relief than placebo or paracetamol (Tylenol). Moreover, some people complained about feelings of sickness or developed a rash .
In two DB-RCTs of 40 and 55 people with lumbar spinal stenosis, calcitonin nasal spray had no effect on the condition [54, 55].
On the contrary, a clinical trial of 90 patients with lumbar spinal stenosis showed that calcitonin nasal spray decreased the symptoms of the disease more effectively than an anti-epileptic drug (gabapentin) and the placebo .
Studies suggest that calcitonin acts on both osteoclasts (bone cells) and chondrocytes (cartilage cells), indicating that its mechanism may be helpful for osteoarthritis .
However, two clinical trials of 2,026 patients with osteoarthritis showed that it had no significant therapeutic effect .
Possibly Ineffective for:
Bipolar disorder or manic-depressive disorder is characterized by abnormal shifts in mood, energy, and activity levels. Mania is a phase of bipolar disorder during which the patient feels increased optimism, euphoria, and hyperactivity .
Double-blind trials conducted in the early 1980s showed that calcitonin injections decreased irritability, euphoria, and hyperactivity in mania patients. Although these results were promising, there were no follow-up studies .
Some scientists thought that calcitonin may stabilize the nerve function and prevent calcium signaling. According to this still unproven theory, calcitonin may assist the function of serotonin while opposing the function of dopamine. Both neurotransmitters have been associated with bipolar disorders .
However, a more recent clinical trial showed that calcitonin had no effect on 46 adults with treatment-resistant mania .
Insufficient Evidence for:
Bone Pain in Bone Metastasis
In a study of 20 patients with bone metastases, calcitonin injections decreased pain significantly compared to placebo .
In another clinical trial of 23 patients with multiple myeloma, calcitonin nasal spray together with calcium increased bone volume, cortical bone (the hard exterior of the bones) thickness, osteoid (the organic component of the bone) thickness and volume .
Large-scale clinical trials are lacking.
Jaw Tumor Recurrence
There is insufficient evidence about the effects of calcitonin on jaw tumor recurrence.
Giant cell lesions of the jaws (central giant cell granuloma) is a benign condition of the jaws and is more common among women and people aged between 20 and 40 .
In a double-blind clinical trial of 24 patients who had surgery for their central giant cell granuloma, calcitonin nasal spray decreased the risk of recurrence compared to placebo in both upper and lower jaws .
In a small study of 5 patients with giant cell lesions of the jaws, calcitonin decreased the lesions and there was no reappearance of the condition. Large-scale trials are warranted .
Types of Calcitonin
Nasal Spray (Miacalcin)
There are two calcitonin peptide drugs approved in the US, human and salmon calcitonin. Salmon calcitonin is more therapeutically effective than the human calcitonin .
Salmon calcitonin is the only marketed drug. It is FDA-approved and available in two forms [68, 69]:
- Injections (Calcitonin Salmon Injection)
- Nasal spray (known as Miacalcin)
The nasal spray is indicated for bone loss in women with osteoporosis. Women should make sure to get enough vitamin D and calcium when using Miacalcin. Your doctor may recommend supplements if your dietary intake is not enough .
Which Form Is More Effective?
In a double-blind study of 204 patients with spine fracture, calcitonin injections had the same pain-relief results as the nasal spray .
However, a systematic review including 246 patients with osteoporosis shows injections were more effective in decreasing acute pain than nasal sprays .
In another study (DB-RCT) in 565 women with osteoporosis, oral calcitonin caused a greater increase in hip, lower back, and total bone density and a larger decrease in bone loss markers compared to the nasal spray and placebo, while being equally safe and tolerable .
In patients with hypercalcemia (elevated calcium levels), the nasal spray was not effective whereas the injections lowered the calcium levels in the blood .
In patients with Paget’s disease, injections were more effective than the nasal spray .
For hypercalcemia, only the injections should be used.
Calcitonin is also being developed as tablets that are resistant to stomach acid. They suspect that water, food intake, and time of use may play an important role in the effectiveness of oral calcitonin. Taking the calcitonin tablet with 50 – 200 ml water, in the evening, 4 hours after eating and 1 hour before the next meal maximize its therapeutic effect [75, 76].
Calcitonin Side Effects & Precautions
This list does not cover all possible side effects. Contact your doctor or pharmacist if you notice any other side effects.
Call your doctor for medical advice about side effects. In the US, you may report side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada, you may report side effects to Health Canada at 1-866-234-2345.
Side Effects List
Calcitonin may cause gut-related side effects including [77, 72, 58]:
- Loose stools
- Stomach pain
- Dyspepsia (impaired digestion)
The following side effects have also been reported :
- Injection site inflammation
- Flushing of the face and hands
- Increased urination at night
- Eye pain
Calcitonin & Cancer Risk
The effects of calcitonin on cancer risk is still an area of research. However, a meta-analysis of 21 clinical trials suggested an increased risk of overall malignancies in calcitonin-salmon-treated patients .
In a study of 28,222 women with osteoporosis, calcitonin significantly elevated the risk of liver cancer but reduced the risk of breast cancer. However, the risk of liver cancer was higher only among the high-dose users .
A study of 9,995 patients with osteoporosis showed that calcitonin is correlated with a higher risk of cancer compared to bisphosphonates and selective estrogen receptor modulators (SERMs), both drugs used for osteoporosis .
However, a different review suggested that calcitonin does not cause or increase tumors and that there is no causal relationship between this hormone and cancer .
Warning: In Europe, calcitonin is not recommended for osteoporosis due to the risk of cancer. It is only recommended for short-term use for Paget’s disease, hypercalcemia, and acute bone loss.
In the US, the FDA recommends calcitonin for osteoporosis only if no other treatment is suitable. Patients should discuss the benefits and risks ratio with their doctors in detail before starting treatment [81, 82].
Calcitonin reduces lithium levels in the blood, as calcitonin increases the amount of lithium flushed with the urine. The dose of lithium may require adjustment .
Calcitonin vs. Parathyroid Hormone and Calcitriol
Parathyroid Hormone and Calcitonin
Parathyroid hormone is a hormone produced in the parathyroid gland, which is behind the thyroid gland. Its function is to increase calcium levels when they are too low. It triggers the release of calcium from bones to the blood, decreases the loss of calcium in the urine, and increases calcium absorption from food .
Basically, it has the opposite effect of calcitonin.
Both hormones are responsible for maintaining healthy levels of calcium in the blood and are used to treat osteoporosis. More research is needed to potentially discover a combination therapy .
Calcitonin and Calcitriol
Calcitriol is another molecule that acts in opposition to calcitonin. Calcitriol (1α,25-dihydroxyvitamin D3) is a by-product of vitamin D and is produced in the kidneys. Parathyroid hormone, low calcium, and low phosphate levels trigger its production .
Calcitriol increases calcium levels in the blood and can slow the progression of chronic kidney disease and decrease protein levels in the urine .
However, high levels of calcitriol can cause hypercalcemia (elevated calcium levels) .
The main function of calcitriol is to increase the uptake absorption of calcium from the gut. It also works together with parathyroid hormone .
In patients with medullary thyroid cancer, calcitriol reduces the production of calcitonin .
Calcitonin gene (CALCA)
The calcitonin-related polypeptide alpha gene (CALCA) produces three peptide hormones: calcitonin, calcitonin gene-related peptide, and katacalcin .
Some studies have linked having at least one C variant (CC or CT) in rs3781719 with an elevated risk of essential hypertension (high blood pressure) .
Genetic variations (706G>T, and 778C>T) have been correlated with osteoarthritis [92, 93].
Non-SNP genetic variations (microdeletion) may be related to increased risk of osteoporosis and lower bone density .
Also, other genetic variations in this gene (number of repeats) may be associated with bipolar disorder, though much more research is needed .
Calcitonin receptor (CALCR)
CALCR gene produces a G protein-coupled receptor that binds calcitonin .
The variant T in this SNP has been associated with kidney stones in one study .
Two meta-analyses suggested that the C variant is associated with increased bone density in the lumbar spine [98, 99].
Women with two T variants had decreased bone density and increased risk of osteoporosis, whereas the C variant was associated with increased bone density and lower risk of bone fractures [100, 101].
According to another study, the C variant was linked with reduced risk of fluorosis (bone disease induced by very high levels of fluoride in the bones) .
The T variant was associated with kidney stones risk [103, 104].
Other Osteoporosis Medications That May Help Prevent Spinal Fractures
There are many different types of medications that doctors may prescribe to treat osteoporosis and help reduce the risk for a painful spinal fracture. One class of drugs are the bisphosphonates that includes alendronate, ibandronate, risedronate and zoledronic acid. In this article, we include other types of medications your doctor may prescribe to help you avoid or manage low bone mineral density (BMD).
There are a variety of medications your doctor may prescribe to help you avoid or manage low bone mineral density. Photo Source: 123RF.com.
Brand Names: Fortical, Miacalcin
What it does: It helps treat osteoporosis in postmenopausal women who are at least five years beyond menopause. Calcitonin slows bone loss and increases bone density in the spine. It may reduce the risk of spinal fractures.
How to take it: Daily nasal spray or injection.
- The nasal spray is stored in the refrigerator until the first use; then should be kept at room temperature. The nasal spray should be primed (pump bottle until full spray is produced) before the first use.
- Calcitonin nasal spray is administered as a single spray into one nostril each day. Alternate nostrils daily.
- Calcium (at least 1000 mg elemental calcium daily) and vitamin D (at least 400 international units daily) supplements are recommended with the use of calcitonin.
Potential side effects: Runny nose, headache, back pain, or nosebleed. The injectable calcitonin may cause an allergic reaction and flushing of the face and hands, urinary frequency, nausea and a skin rash. There has been an increased risk in the development of cancer with the use of calcitonin nasal spray. Therefore, its use is suggested when alternative treatments are not a suitable option.
Tests required: Blood tests to check calcium levels.
Brand Name: Prolia
What it does: It helps to treat osteoporosis in postmenopausal women at high risk of fracture. Denosumab also increases bone mass in men with osteoporosis at high risk of fracture. This medication may be used to treat bone loss in men and women, who are receiving certain treatment for cancer. The drug may help reduce the risk for breaking bones in the spine, hip and other bones.
How to take it: By injection every six months (in a doctor’s office). Calcium and vitamin D supplements are recommended with the use of denosumab.
Potential side effects: Denosumab may lower the calcium levels in the blood. Signs of low calcium levels include muscle spasms, muscle twitches or cramps; numbness and tingling in the fingers, toes or around the mouth. The drug may also cause skin rashes, back, arm or leg pain, increase in cholesterol levels or infections. Denosumab may cause severe jaw bone problems and unusual fractures in the thigh bone.
Testing required: Blood test before each dose to confirm that blood calcium levels are normal.
Brand Name: Evista
What it does: It helps to prevent and treat osteoporosis in postmenopausal women. Raloxifene increases bone mineral density and reduces the risk of spine fractures. It is approved to decrease the risk of breast cancer in women with osteoporosis and in women without osteoporosis who are at high risk of invasive breast cancer. Raloxifene works by affecting estrogen receptors in the body.
How to take it: Daily in tablet form with or without food.
Potential side effects: Hot flashes, leg cramps, swelling and temporary flu-like symptoms. This medication may increase the risk for blood clots (deep-vein thrombosis vein thrombosis and pulmonary embolism).
Who shouldn’t use it: Raloxifene should not be taken by women at increased risk for stroke. This includes women who have had previous strokes, transient ischemic attacks (TIA), atrial fibrillation or uncontrolled high blood pressure.
Teriparatide Parathyroid Hormone (PTH) (1-34)
Brand Name: Forteo
What it does: It treats osteoporosis in postmenopausal women and in men at high risk of breaking a bone. It may help reduce the risk of spinal fracture.
How to take it: Self-administered as a daily injection from a preloaded pen that contains a one-month supply of medicine. The medication can be injected into your abdomen or thigh. The medication pen device is stored in the refrigerator.
Potential side effects: Decrease in blood pressure when you change positions, which can cause you to feel dizzy, notice a fast heartbeat or feel faint. This can occur within 4 hours after you take the injection; however, those symptoms usually go away after a few hours. Other side effects include leg cramps, nausea and increase in calcium levels in your blood.
Who shouldn’t use it: People with Paget’s disease (abnormal bone formation), or those whose bones have not fully formed or matured. PTH should not be taken by people with increased blood calcium levels, metabolic bone disease such as hyperparathyroidism, or bone cancer.
Estrogen and Hormone Therapy
Multiple brands available
What it does: It may help prevent osteoporosis in postmenopausal women by reducing bone loss. The therapy may help increase BMD in the spine and hip, and reduce the risk of hip, spine and other fractures. It relieves menopausal symptoms (eg, hot flashes). However, this therapy is no longer a first-line approach for the treatment of osteoporosis due to increased risk of cancer, stroke or blood clots in other areas of the body.
How to take it: In tablet form or as a skin patch (ie, transdermal). Estrogen therapy alone is only prescribed for women who have had a hysterectomy or partial hysterectomy because therapy can increase a woman’s risk of developing endometrial cancer. A progestin hormone is administered with estrogen if a woman has an intact uterus.
Potential side effects: Side effects of estrogen therapy can include vaginal bleeding, breast tenderness, swelling and headache.
Who shouldn’t use it: Women who have had breast cancer or are at high risk for breast cancer. Women who have a history of blood clots.
How Your Doctor Determines if Your Osteoporosis Drug is Working
It is important to make sure the medication your doctor prescribes is effectively working to prevent or manage your osteoporosis and risk for fracture. During your treatment, your doctor will periodically order certain tests.
Tests may include:
- Blood or urine tests to measure enzymes, proteins and other substances predictive of your BMD—the density or strength of your bones.
- Blood tests to measure markers of bone formation, such as bone-specific alkaline phosphatase (Bone ALP or BALP) or osteocalcin; a marker of bone loss called urinary N-telopeptide of type I collagen, or uNTX; and levels of vitamin D, which is essential for the body’s absorption of calcium.
- Bone densitometry, also called bone scanning or dual-energy x-ray absorptiometry (DXA).
Calcitonin is a hormone known to participate in calcium and phosphorus metabolism. In mammals, the major source of calcitonin is from the parafollicular or C cells in the thyroid gland, but it is also synthesized in a wide variety of other tissues, including the lung and intestinal tract. In birds, fish and amphibians, calcitonin is secreted from the ultimobrachial glands.
Calcitonin is a 32 amino acid peptide cleaved from a larger prohormone. It contains a single disulfide bond, which causes the amino terminus to assume the shape of a ring. Alternative splicing of the calcitonin pre-mRNA can yield a mRNA encoding calcitonin gene-related peptide; that peptide appears to function in the nervous and vascular systems. The calcitonin receptor has been cloned and shown to be a member of the seven-transmembrane, G protein-coupled receptor family.
Physiologic Effects of Calcitonin
A large and diverse set of effects has been attributed to calcitonin, but in many cases, these were seen in response to pharmacologic doses of the hormone, and their physiologic relevance is suspect. It seems clear however, that calcitonin plays a role in calcium and phosphorus metabolism. In particular, calcitonin has the ability to decrease blood calcium levels at least in part by effects on two well-studied target organs:
- Bone: Calcitonin suppresses resorption of bone by inhibiting the activity of osteoclasts, a cell type that “digests” bone matrix, releasing calcium and phosphorus into blood.
- Kidney: Calcium and phosphorus are prevented from being lost in urine by reabsorption in the kidney tubules. Calcitonin inhibits tubular reabsorption of these two ions, leading to increased rates of their loss in urine.
It seems clear that there are species differences in the importance of calcitonin as a factor affecting calcium homeostasis. In fish, rodents and some domestic animals, calcitonin appears to play a significant role in calcium homeostais. In humans, calcitonin has at best a minor role in regulating blood concentrations of calcium. One interesting piece of evidence to support this statement is that humans with chronically increased (medullary thyroid cancer) or decreased (surgical removal of the thyroid gland) levels of calcitonin in blood usually do not show alterations from normal in serum calcium concentration.
Addition information on calcitonin and calcium balance can be found in the section Endocrine Control of Calcium and Phosphate Homeostasis.
Control of Calcitonin Secretion
The most prominent factor controlling calcitonin secretion is the extracellular concentration of ionized calcium. Elevated blood calcium levels strongly stimulate calcitonin secretion, and secretion is suppressed when calcium concentration falls below normal. A number of other hormones have been shown to stimulate calcitonin release in certain situations, and nervous controls also have been demonstrated.
A large number of diseases are associated with abnormally increased or decreased levels of calcitonin, but pathologic effects of abnormal calcitonin secretion per se are not generally recognized.
There are several therapeutic uses for calcitonin. It is used to treat hypercalcemia resulting from a number of causes, and has been a valuable therapy for Paget disease, which is a disorder in bone remodeling. Calcitonin also appears to be a valuable aid in the management of certain types of osteoporosis.
Advanced and Supplemental Topics
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Calcitonin is a thyroid hormone synthesized in parafollicular cells, one of the main regulators of calcium-phosphorus metabolism.
Calcitonin, thyrocalcitonin, thyrocalcitonin, TKT.
Calcitonin, Human calcitonin, Thyrocalcitonin, Ct.
Solid-phase chemiluminescent enzyme-linked immunosorbent assay (“sandwich” method).
Detection range: 0.5 – 200000 pg / ml.
Pg / ml (picograms per milliliter).
What biomaterial can be used for research?
How to properly prepare for the study?
- Do not eat within 12 hours prior to examination.
- Stop taking oral contraceptives one month before the study.
- Eliminate physical and emotional stress the day before the study.
- Do not smoke for 3 hours prior to examination.
General information about the study
Calcitonin is a thyroid hormone formed in parafollicular cells (C-cells), one of the most important regulators of calcium-phosphorus metabolism.
The formation of calcitonin directly depends on the level of calcium in the blood: when it rises, the concentration of calcitonin increases, and when it falls, it decreases. Once in the blood, calcitonin quickly disappears from it; its half-life, according to various sources, ranges from 2 to 15 minutes.On osteocytes (bone cells) there are special receptors, acting on which, calcitonin increases the flow of calcium from the blood to the bone, which inhibits the resorption (destruction, decrease in mineral density) of the bone. Thus, the action of calcitonin is aimed at lowering blood calcium levels, inhibiting bone demineralization.
Calcitonin is a direct antagonist of parathyroid hormone (PTH), a hormone of the parathyroid glands. The action of PTH is directly opposite to that of thyrocalcitonin, although it is also regulated by the concentration of calcium in the blood.It removes calcium from the bones to maintain the correct concentration in the blood. Calcitonin and PTH in a healthy person, interacting with each other, are in balanced amounts for the normal regulation of calcium-phosphorus metabolism, which is mainly responsible for bone density. Vitamin D 3 plays an important role in the regulation of the PTH-calcitonin bond. Thus, the measurement of the level of calcitonin is primarily advisable in violation of calcium-phosphorus metabolism caused by primary osteoporosis.It should be remembered that calcitonin levels need to be assessed in conjunction with other markers of bone remodeling.
In secondary osteoporosis (which resulted from hypercortisolism, hypogonadism, thyrotoxicosis, hyperparathyroidism), the level of calcitonin does not decrease.
The calcitonin test is extremely important for the diagnosis of medullary thyroid cancer, including the detection of multiple endocrine neoplasia syndrome (MEN-IIa, Sipple’s disease), which can manifest as medullary cancer, a tumor of the adrenal medulla (pheochromocytoma) or hyperplasia and parathyroid gland hyperparathyroidism.
An increase in the concentration of calcitonin in the blood serum during the test with pentagastrin is the main diagnostic criterion for the presence of medullary thyroid carcinoma, according to the results of the study, the stage of the disease and the size of the tumor are judged. After administration of pentagastrin, the level of calcitonin increases in almost all patients with medullary thyroid cancer. If it was already increased, then during the test with pentagastrin it will increase by 10-20 times. When the level of calcitonin is at the lower limits of the norm or is not determined at all, and after stimulation with pentagastrin it rises significantly, but does not go beyond the normal range, an early stage of medullary cancer or hyperplasia of thyroid C-cells is suspected.In some patients, intravenous calcium supplementation should be used as stimulation, as tumors may not respond to pentagastrin.
Calcitonin test is prescribed after surgical treatment of medullary thyroid carcinoma to assess the results of the operation. In particular, it is recommended to take it in the late postoperative period in order to monitor whether the medullary carcinoma has metastases and whether there is a recurrence of the tumor.
Since the secretion of calcitonin can be influenced by enzymes of the gastrointestinal tract (pepsin), glucagon produced by the pancreas, diseases of these organs (pancreatitis, acute cholecystitis, cirrhosis of the liver) can indirectly affect the synthesis of calcitonin.
What is the research used for?
- For the diagnosis of medullary thyroid cancer.
- For the detection of multiple endocrine neoplasia syndrome (MEN-IIa, Sipple’s disease), which can manifest as medullary cancer, adrenal medulla tumor (pheochromocytoma) or parathyroid hyperplasia and hyperparathyroidism.
- To find out if there are metastases of medullary thyroid cancer.
- For indirect estimation of the size of medullary carcinoma.
- To evaluate the outcome of surgery to remove medullary thyroid cancer.
- For the diagnosis of primary osteoporosis.
- For the diagnosis of hyper- and hypoparathyroidism.
When is the study scheduled?
- In case of suspicion of medullary carcinoma (with nodular formations of the thyroid gland, an increase in its size, an increase in regional lymph nodes).
- For diagnosed pheochromocytoma, hyperparathyroidism, to exclude multiple endocrine neoplasia syndrome (MEN IIa).
- Before and after surgery to remove medullary carcinoma.
- If any of the patient’s relatives had medullary cancer.
- For symptoms of osteoporosis (bone pain, bone deformation and multiple fractures) for a comprehensive assessment of calcium metabolism disorders.
- For violations of calcium-phosphorus metabolism (with hyper-, hypoparathyroidism).
What do the results mean?
‹6.4 pg / ml
‹9.52 pg / ml
Causes of increased serum calcitonin levels:
- Medullary thyroid cancer,
- C-cell hyperplasia,
- Certain cases of lung, breast or pancreas, prostate cancer,
- Zollinger-Ellison syndrome,
- pernicious anemia,
- renal failure,
- alcoholic cirrhosis,
- some types of benign tumors,
- estrogen use,
- use of testosterone preparations,
- Paget’s disease,
- pregnancy (third trimester),
- intravenous administration of calcium preparations.
Causes of decreased serum calcitonin levels:
- primary osteoporosis,
- hypoparathyroidism (including pseudohypoparathyroidism),
- lack of synthesis of calcitriol in the kidneys,
What can influence the result?
- Intense physical activity.
- Intravenous administration of calcium preparations.
- Hyperinsulinemia due to high carbohydrate intake.
- Excessive alcohol consumption prior to the test.
- Treatment with preparations of female sex hormones (hormone replacement therapy with estrogens).
Download an example of the result
Who orders the study?
Endocrinologist, oncologist, therapist, surgeon, general practitioner, pediatrician.
- Eur J Endocrinol.2010 Jun; 162 (6): 1141-5. Epub 2010 Mar 23. Calcitonin screening and pentagastrin testing: predictive value for the diagnosis of medullary carcinoma in nodular thyroid disease. Herrmann BL, Schmid KW, Goerges R, Kemen M, Mann K.
- Otolaryngol Clin North Am. 1990 Jun; 23 (3): 453-73 Surgical treatment of medullary carcinoma of the thyroid. Block M.A.
- Calcitonin and bone formation: a knockout full of surprises. Mone Zaidi, Baljit S. Moonga, and Etsuko Abe. 2002, American Society for Clinical Investigation
- Surgery.2011 Dec; 150 (6): 1168-77.Preoperative basal calcitonin and tumor stage correlate with postoperative calcitonin normalization in patients undergoing initial surgical management of medullary thyroid carcinoma.Yip DT, Hassan M, Pazaitou-Panayiotou K, Ruan DT, Gawande AA ,
- Presse Med. 2011 Dec; 40 (12 Pt1): 1141-6. Epub 2011 Oct 27. Calcitonin: indications and interpretation. d’Herbomez M. Université de Lille-II, 59000 Lille, France
- Rev Med Interne. 2006 Aug; 27 (8): 610-5.Epub 2006 Apr 19. How to interprete hypercalcitoninemia? Levy-Bohbot N, Patey M, Larbre H, Hecart AC, Caron J, Delemer B.
Description CALCITONIN indications, dosages, contraindications of the active substance CALCITONIN
In the case when a patient has a hypersensitivity to protein (including a history), the prescription of calcitonin preparations is possible only after allergic skin tests.
With the first injection of calcitonin (or with several initial injections), hypocalcemia may develop, sometimes accompanied by tetany, therefore, for emergency assistance, a calcium preparation (for example, calcium gluconate) for parenteral administration should be available.
With prolonged use of salmon calcitonin, which is a foreign protein for humans, the formation of antibodies is possible. With a treatment duration of 2 years or less, the appearance of antibodies was noted in 30-60% of patients, while the formation of resistance to treatment was observed in 5-15%. Longer treatment (more than 2 years) is possible only in the absence of antibody formation.
In Paget’s disease during treatment with calcitonin, there is a decrease in the concentration of alkaline phosphatase in the serum (which reflects a decrease in osteogenesis) and a decrease in the excretion of hydroxyproline in the urine (which reflects a decrease in bone resorption, in particular the breakdown of collagen).The most pronounced decrease in the values of these indicators, reflecting the positive effect of treatment, is observed after 6-24 months of continuous treatment. Monitoring the concentration of alkaline phosphatase in serum and daily urinary excretion of hydroxyproline should be carried out before treatment, regularly in the first 3 months and every 3-6 months during long-term treatment.
During the treatment of patients with hypercalcemia, systematic monitoring of serum calcium concentration is shown.
Influence on the ability to drive vehicles and mechanisms
During the period of use of calcitonin, it is recommended to be careful when driving vehicles and engaging in other activities that require a high concentration of attention and speed of psychomotor reactions.
Calcitonin (Calcitonin) – find out the prices for analysis and pass in Simferopol
What is Calcitonin?
Calcitonin (Calcitonin) is a thyroid hormone that is involved in the regulation of calcium metabolism in the body.
Calcitonin is produced by special cells in the thyroid gland called C cells. These cells are located in the thyroid gland outside the follicles, which make up the main tissue of the organ and perform the main function – the synthesis of thyroxine and triiodothyronine (hormones called T4 and T3 for short).
Why is blood calcitonin measured?
Calcitonin determination is used to detect C-cell hyperplasia and medullary thyroid cancer.
These are rare conditions. With hyperplasia, thyroid C cells grow abnormally and begin to secrete more calcitonin. In even rarer cases, hyperplasia can progress, and the cells degenerate into malignant – medullary cancer.
Medular thyroid cancer is a malignant tumor that tends to metastasize.This means that abnormal cells can spread outside the thyroid gland with blood, lymph, grow into neighboring organs, forming metastases.
Medullary cancer is a rare disease, it occurs in less than 5% of cases of thyroid cancer. At the same time, about a quarter of cases occur in patients with type II multiple endocrine neoplasia syndrome (MEN 2). In this case, the diagnosis is often made on the basis of a combination of serious health problems.It is a hereditary disorder (requires genetic testing to confirm the diagnosis) and is rare.
In what diseases is the level of calcitonin in the blood increased?
The level of calcitonin increases in medullary thyroid cancer, syndrome of multiple endocrine neoplasia of the second type, hyperplasia of C-cells of the thyroid gland, in some cases in tumor (benign and malignant) processes in other organs: lungs, pancreas, mammary glands, neuroendocrine system, in pheochromocytoma, APUD cell tumors, myeloproliferative diseases, leukemia, etc.The level of calcitonin can also increase with inflammatory processes occurring both in the thyroid gland (thyroiditis) and outside it – with chronic kidney disease, renal failure (including uremia), liver disease (for example, with cirrhosis), with pancreatitis (inflammation of the pancreas).
Why might the analysis result be incorrect?
The concentration of calcitonin in the blood can be influenced by pregnancy, intense psycho-emotional and physical activity (including sports training) on the eve of the test, alcohol consumption during the previous day, smoking an hour before the test.
Detection limits: 1-80000 pg / ml.
Interpretation of test results contains information for the treating physician and does not constitute a diagnosis. The information in this section cannot be used for self-diagnosis and self-medication. An accurate diagnosis is made by a doctor, using both the results of this examination and the necessary information from other sources: anamnesis, results of other examinations, etc.d.
Interpretation of the results of determining the level of Calcitonin in serum
Units of : pg / ml.
|Floor||Age||Calcitonin level, pg / ml||Comment||Source|
|Both||up to 3 years||<15||Children under 3 years of age – general extended comment on RH: “Guideline reference values: newborns 1 month.- <33.8 pg / ml; further decrease by 1 year <14.0 pg / ml; by 2 years <8.49 pg / ml "||J Clin Endocrinol Metab, 2015, 100: 1780-1784|
|Women||Over 3 years old||<4.8||–||insert|
|Men||Over 3 years old||<11.8||–||insert|
Calcitonin levels above 100 pg / ml are observed in medullary carcinoma, leukemia, and lymphoproliferative diseases.
- Medullary thyroid cancer.
- C-cell hyperplasia.
- Certain cases of lung, breast, or pancreatic cancer.
- Zollinger-Ellison Syndrome.
- Pernicious anemia.
- Chronic renal failure.
- Cell tumors of the APUD system.
- Carcinoid syndrome.
- Alcoholic cirrhosis.
- Benign lung tumors.
- Leukemia and myeloproliferative diseases.
- Other types of tumors, especially of a neuroendocrine nature.
- Chronic inflammatory diseases.
Decrease in values (under dynamic observation): exercise.
Calcitonin test – prices, take in Yaroslavl in Invitro
Method of determination
Synonyms: Calcitonin blood test; Thyrocalcitonin; Thyrocalcitonin; TKT. Calcitonin; Human Calcitonin; Thyrocalcitonin; CT.
General information about the Calcitonin study
Calcitonin is a peptide hormone produced mainly by parafollicular C-cells of the thyroid gland, as well as in small amounts in other organs (most noticeably in the lungs).Receptors for calcitonin are found on osteoclasts, monocytes, kidneys, brain, pituitary gland, placenta, gonads, lungs and liver, but the physiological role of this hormone in the body is not yet clear enough. Calcitonin has a hypocalcemic effect by inhibiting the activity of osteoclasts and reducing the rate of bone resorption, reducing calcium reabsorption in the kidneys and decreasing calcium absorption in the intestine. It lowers renal phosphate reabsorption, causing a moderate decrease in blood phosphorus.This hormone is functionally an antagonist of parathyroid hormone, but its role in the regulation of calcium-phosphorus metabolism in the human body, in comparison with parathyroid hormone, is small. Neither the decrease in serum calcitonin levels after thyroidectomy, nor its significant excess in medullary thyroid carcinoma, cause significant changes in serum calcium levels, or a noticeable decrease or increase in bone mass. The level of secretion of calcitonin is modulated by an increase and decrease in blood calcium (an increase in blood calcium causes an increase in calcitonin levels).It is metabolized mainly in the kidneys, with renal failure, an increase in the level of calcitonin may be observed.
In laboratory diagnostics, calcitonin is used as a biochemical marker of medullary thyroid cancer associated with malignant transformation of thyroid C-cells. The level of this hormone in the blood serum of patients with medullary thyroid carcinoma is increased and increases even more after administration of calcium and / or pentagastrin, which is used in doubtful cases for provocative stimulating tests.An increase in calcitonin levels can be observed before the onset of clinical manifestations. Since up to 20% of cases of medullary thyroid carcinoma are familial, which indicates a genetic predisposition, the determination of the calcitonin level is used in screening examinations of the patient’s family members. It should be noted that the results of a biochemical study by themselves cannot serve as a basis for a diagnosis. Calcitonin can be produced by many other cancers, especially those of a neuroendocrine nature.Calcitonin in thyroid tissue and serum in patients with medullary carcinoma may be present in heterogeneous forms. Due to immunochemical heterogeneity and the use of antisera specific for different epitopes in different methods, the results of calcitonin determination are largely method-dependent.
What can affect the result of a blood test for Calcitonin
In a small proportion of patients with medullary cancer, fasting calcitonin levels are normal.In these cases, a provocative test using calcium or pentagastrin should be performed. Calcitonin levels increase during pregnancy and in newborns. It is necessary to take into account the circadian rhythm of calcitonin with an increase in concentration by noon.
For what purpose is the level of Calcitonin in the blood serum determined
Calcitonin is used as a marker of medullary thyroid cancer. Measurement of the level of this hormone is also carried out to assess the effectiveness of removal of this tumor and subsequent monitoring.It is advisable to use the test in screening examinations of family members of patients with medullary thyroid cancer.
90,000 Department of Medicines – Calcitonin linked to cancer risk
Calcitonin is associated with cancer risk
Calcitonin linked to cancer risk
The European equivalent of the US FDA yesterday recommended that the nasal spray calcitonin – indicated for the treatment of osteoporosis in the European Union – be discontinued due to the increased risk of cancer.
The European Medicines Agency (EMA) also reported that long-term use of drugs containing calcitonin, given by injection or infusion, increases the risk of cancer. As a consequence, the EMA recommended only short-term use of these drugs for three conditions that were previously approved in the European Union: Paget’s disease, acute bone loss due to urgent immobilization, and hypercalcemia caused by cancer. Calcitonin in any form should no longer be used to treat osteoporosis for other reasons, the agency said.
In the United States, the FDA has approved 2 versions of nasal calcitonin for the treatment of postmenopausal osteoporosis in women: Fortical Fortical (Upsher-Smith Laboratories) and Miacalcin Miacalcin (Novartis). The instructions for both medicines do not contain information about restricting use or warning about the risk of cancer.
Calcitonin, also called salmon calcitonin, is a synthetic copy of a hormone polypeptide secreted by the peri-occipital gland of salmon.
According to the agency, this statement is based on the recommendations of their review of the risks and benefits of medications containing calcitonin.Conducted by the Agency’s Committee on Medicinal Products for Use in Humans (CHMP), the review looked at the available data from companies selling these drugs, post-marketing safety data, controlled randomized trials, two trials of unlicensed oral calcitonin drugs, and experimental cancer studies from other sources.
CHMP found that “patients treated with calcitonin for an extended period of time were more likely to develop different types of cancer compared with patients taking placebo.”The increase in cancer incidence ranged from 0.7% with the oral formulation to 2.4% with the nasal spray. The CHMP concluded that the benefits of using calcitonin did not outweigh the risks. The only indication for a nasal spray is osteoporosis, so its removal from the market is warranted.
As an option for injection or infusion, calcitonin should be given for no more than 4 weeks to prevent acute bone loss after urgent immobilization and generally no more than 3 weeks to treat Paget’s disease, the agency said.However, the EMA does not regulate the short-term use of calcitonin for the treatment of cancer-induced hypercalcemia.
The EMA Calcitonin Recommendations have been forwarded to the European Commission, the executive arm of the European Union, for further action. More information on EMA guidelines is available on the agency’s Web site.
Pathogenetic basis and efficacy of calcitonin prepatates and slow calcium channel blockers in the treatment of peptic ulcer disease recurrence | Fomina
1.Filimonov R.M. Spa treatment of diseases of the digestive system. – M .: “Polygraphist”, 2012. – S. 90-176.
2. Zimmerman Y.S. Unsolved and controversial problems of modern gastroenterology. – M .: “Medpressinform”, 2013. – S. 85-124
3. Chernin V.V. Diseases of the esophagus, stomach and duodenum Guide for physicians. – M .: “Medical Information Agency”, 2010.- S. 262-423.
4. Mosin V.I. Peptic ulcer: Hormonal aspects of pathogenesis. Stavropol, 1981 .– 181 p.
5. Chernin V.V. Clinical and experimental aspects of the pathogenesis, sanogenesis and treatment of peptic ulcer disease. Tver, 1994 .– 256 p.
6. Chernin V.V., Fomina L.A., Khomullo G.V. The value of the calcium-regulating system in the pathogenesis of experimental gastric ulcer in rabbits. // Experimental and Clinical Gastroenterology. – 2010. – No. 11. – S. 63-66.
7. Eastell R., Arnold A., Brandi M.L., Brown E.M., D’Amour P., Hanley D.A. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. // J Clin Endocrinol Metab. – 2009.- V. 94 (2). – P. 340-350.
8. Kleinpeter M.A. Spectrum of complications related to secondary hyperparathyroidism in a peritoneal dialysis patient. // Adv. Perit. Dial. – 2000. – Vol. 16. – P. 286-290.
9. Kisfalvi I., Földväri P., Szücs K. Effect of calcitonin on bombesin-stimulated gaslric acid secretion in patients with duodenal ulcer.// Acta Med Acad Sci Hung. – 1982. – V. 39 (3-4). – P. 179-185.
10. Jonderko G.I., Jonderko K., Goiab T. Effect of calcitonin on gastric emptying and postprandial secretion of gastrin and insulin in patients with duodenal ulcer. // Przegl Lek. – 1990. – V. 47 (11). – P. 746-749.
11. Feng J.1., Petersen C. D., Coy D. H., Jiang J.K., Thomas C. J., Pollak M. R., Wank S. A. Calcium-sensing receptor is a physiologic multimodal chemosensor regulating gastric G-cell growth and gastrin secretion. // Proc Natl Acad Sci U S A. 2010. Oct 12. V. 107 (41). – P. 17791-17796.
12. Survé V.V., Hâkanson R. Evidence that peroral calcium does not activate the gastrin-ECL-cell axis in the rat. // Regul Pept. 1998. – Feb 27. – V. 73 (3). P. 177-182.
13.Fomina L.A., Chernin V.V. Calcium-regulating system in the pathogenesis of peptic ulcer disease, microcirculation and hemostasis disorders. // Experimental and clinical gastroenterology. – 2014. – No. 6 (106). – S. 38-42.
14. Fomina L.A. Pathogenetic bases of the use of calcium antagonists in the treatment of recurrent peptic ulcer disease. // Experimental and clinical gastroenterology. – 2003. – No. 4. – S. 41-48.
15.Biochemistry: textbook for universities / ed. E.S. Severin – 5th ed. – M .: GEOTAR-Media, – 2009 .– 768 p.
Donate Calcitonin, blood, pg / ml, (Siemens) analysis in Vladimir
Endocrinology – Calcitonin (Siemens), blood, pg / ml
Terms of execution: 1 working day *.
Preparation for the study: on an empty stomach, at least 8 hours should pass between the last meal and blood sampling, 3 days before the study, increased physical activity must be excluded, alcohol intake per day, smoking for 1 hour.
Reference: Calcitonin is a hormone that regulates calcium metabolism and is a parathyroid hormone antagonist. It is produced mainly by parafollicular C-cells of the thyroid gland, as well as in small amounts by the lungs and some other organs. Receptors for calcitonin are found on osteoclasts, monocytes, kidneys, brain, pituitary gland, placenta, gonads, lungs and liver. Calcitonin has a hypocalcemic effect by inhibiting the activity of osteoclasts and reducing the rate of bone resorption, reducing calcium reabsorption in the kidneys and decreasing calcium absorption in the intestine.It lowers renal phosphate reabsorption, causing a moderate decrease in blood phosphorus. This hormone is functionally an antagonist of parathyroid hormone, but in comparison with it, the role of calcitonin in the regulation of calcium-phosphorus metabolism in the human body is small.