Calcitonin-Salmon (Fortical® and Miacalcin®)
Calcitonin is a synthetic hormone for the treatment of osteoporosis in postmenopausal women who are at least five years beyond menopause. The naturally occurring hormone is involved in calcium regulation and bone metabolism.
Calcitonin slows bone loss and increases bone density in the spine. It reduces the risk of spine fractures but has not been shown to decrease the risk of non-spine fractures.
Calcitonin is available as a nasal spray (200 IU daily) or an injection (dosage varies). An oral form of the drug is also being tested in clinical trials.
Side Effects
Common side effects with nasal calcitonin are a runny nose, headache, back pain and nosebleed (epistaxis). Injectable calcitonin may cause an allergic reaction and unpleasant side effects including flushing of the face and hands, urinary frequency, nausea and a skin rash.
Denosumab (Prolia)
Denosumab is approved by the FDA for the treatment of osteoporosis in postmenopausal women at high risk of fracture and to increase bone mass in men with osteoporosis at high risk of fracture. The medicine is also approved to increase bone mass in men at high risk of fracture receiving androgen deprivation therapy for nonmetastatic prostate cancer and treatment to increase bone mass in women at high risk for fracture receiving adjuvant aromatase inhibitor therapy for breast cancer.
Denosumab is a RANK ligand (RANKL) inhibitor/human monoclonal antibody. A healthcare professional gives denosumab by injection every six months. Patients need to have a blood test before each dose to confirm that blood calcium level is normal. As for all people with osteoporosis, it is very important to get enough calcium, vitamin D and exercise everyday.
Denosumab reduces the risk of broken bones in the spine, hip and other bones. In clinical trials, denosumab significantly reduced the incidence of new spine fractures by 68 percent, reduced the incidence of hip fractures by 40 percent and reduced the incidence of all non-spine fractures by 20 percent over three years.
Side Effects
Denosumab may lower the calcium levels in the blood. If blood calcium levels are low before receiving denosumab, the low calcium level must be corrected before giving the medicine or it will get worse. Signs of low calcium levels include spasms, twitches or cramps in the muscles; or numbness and tingling in the fingers, toes or around the mouth. If any of these symptoms are seen while on this medicine, patients should contact their healthcare provider. Most patients with low calcium levels, however, do not show these signs.
People who have weak immune systems or take other medicines that affect the immune system may have an increased chance of having serious infections with denosumab. Even patients who have no immune system problems may be at higher risk of certain infections such as those of the skin. Patients should contact their healthcare provider right away if signs of infection occur. These signs may include fever, chills, red and swollen skin, skin that is hot or sore to the touch, severe pains in the abdomen, or pain or burning when passing urine or passing urine more frequently and in small amounts.
Denosumab may also cause skin rashes. Call your healthcare provider if you notice any abnormal skin-related symptoms. Denosumab has caused osteonecrosis of the jaw (ONJ) when used to treat patients with cancer although at this time, these have not been seen in patients with osteoporosis. Patients should practice good dental care during treatment and should have an examination of the mouth by a doctor or dentist before starting the medicine.