Evaluation of the impact of calcitonin nasal spray on bone density: A literature review

Abstract

There is inadequate evidence-based literature for clinicians supporting the role of adjuvant rehabilitation options in cases of bone deficient pathologies, and fractures. A literature search was done from e-resources such as DELNET, J-gate, Scopus, Web of Science, EBSCO & PubMed from 18 May 2000 to 28 August 2024. The search was performed through the student's corner at our university with keywords such as bone density, calcitonin, calcitonin nasal spray, fractures, and pathology. Thirteen studies were included following the inclusion and exclusion criteria. The reviews emphasized that skeletal muscles typically require 18–24 hours to reach peak responsiveness to calcitonin, while patients with high-turnover osteoporotic syndromes often exhibit a quicker bone response even at lower dosages. A weekly dose of 250-2800 IU (International Unit) calcitonin resulted in a substantial increase in bone density. The side effects of calcitonin therapy are mild and short-term: transient nausea and gastric discomfort were reported in 8 to 10 % of the patients, while facial flushing and skin hypersensitivity occurred in 2 to 5 %. The relatively low bioavailability of calcitonin in nasal formulations also limits its utility. Methodological limitations of the reviewed studies include variability in BMD (bone mineral density) assessment methods, potential selection bias, small sample sizes, and lack of blinding in some trials. Calcitonin enhances bone density at weekly dosages of more than 250 IU thereby lowering the risk of fractures. This literature review provides us with an understanding of the potential future applications of calcitonin nasal spray as an adjuvant for enhancing bone mineralization in patients with pathologies and fractures.