Calcitonin is a polypeptide hormone secreted by the parafollicular cells of the thyroid gland in mammals and by the ultimobranchial gland of birds and fish.
The active ingredient in FORTICAL® calcitonin-salmon (rDNA origin) Nasal Spray is a polypeptide of 32 amino acids manufactured by recombinant DNA technology and is identical to calcitonin-salmon produced by chemical synthesis.
This is shown by the following graphic formula.
FORTICAL® calcitonin-salmon (rDNA origin) Nasal Spray is indicated for the treatment of postmenopausal osteoporosis in women greater than 5 years postmenopause with low bone mass relative to healthy premenopausal women. Use of FORTICAL® calcitonin-salmon (rDNA origin) Nasal Spray is recommended in conjunction with an adequate calcium (at least 1000 mg elemental calcium per day) and Vitamin D (400 International Units per day) intake to retard the progressive loss of bone mass. The evidence of efficacy for calcitonin-salmon is based on increases in spinal bone mineral density (BMD) observed in clinical trials.
Two randomized, placebo-controlled trials were conducted in 325 postmenopausal women (227 treated with calcitonin-salmon nasal spray and 98 treated with placebo) with spinal, forearm or femoral BMD at least one standard deviation below the normal value for healthy premenopausal women. These studies conducted over two years demonstrated that 200 International Units daily of calcitonin-salmon nasal spray increases lumbar vertebral BMD relative to baseline and relative to placebo in osteoporotic women who were greater than 5 years postmenopause. Calcitonin-salmon nasal spray produced statistically significant increases in lumbar vertebral BMD compared to placebo as early as 6 months after initiation of therapy with persistence of this level for up to 2 years of observation.
No effects of calcitonin-salmon nasal spray on cortical bone of the forearm or hip were demonstrated. However, in one study, BMD of the hip showed a statistically significant increase compared with placebo in a region composed of predominantly trabecular bone after 1 year of treatment changing to a trend at 2 years that was no longer statistically significant.
Published Studies Related to Fortical (Calcitonin Nasal)
Efficacy and harms of nasal calcitonin in improving bone density in young patients with inflammatory bowel disease: a randomized, placebo-controlled, double-blind trial. [2011.08]
OBJECTIVES: There are very few published studies of agents having the potential to improve bone health in children with inflammatory bowel disease (IBD). The objective of this study was to establish the efficacy and safety of intranasal calcitonin in improving bone mineral density (BMD) in young patients with IBD and to define additional factors that impact bone mineral accrual... CONCLUSIONS: Intranasal calcitonin is well tolerated but does not offer a long-term advantage in youth with IBD and decreased BMD. Bone mineral accrual rate remains compromised in youth with IBD and low BMD raising concerns for long-term bone health outcomes. Improvement in nutritional status, catch-up linear growth, control of inflammation, increase in weight-bearing activity, and lower daily caffeine intake may be helpful in restoring bone density in children with IBD and low BMD.
The effect of oral salmon calcitonin delivered with 5-CNAC on bone and cartilage degradation in osteoarthritic patients: a 14-day randomized study. [2010.02]
BACKGROUND: The aim of this study was to investigate the pharmacokinetic and pharmacodynamic parameters of oral salmon calcitonin (oSCT) administered over 14 days to men and women presenting with osteoarthritis (OA)... CONCLUSIONS: oSCT given twice daily with a pre-dinner and morning fasting dosing resulted in reductions in markers of bone resorption and cartilage degradation. Copyright 2009 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
Investigations of inter- and intraindividual relationships between exposure to oral salmon calcitonin and a surrogate marker of pharmacodynamic efficacy. [2010.01]
AIMS: The aims of the study were to investigate interindividual variations in the bioavailability of salmon calcitonin (sCT) following single oral 0.8 mg doses at three different times of the day, and intraindividual variation in sCT bioavailability at each end of a 14-day treatment period. We also investigated correlations between exposure to sCT and levels of the bone resorption biomarker serum C-terminal telopeptide of collagen type I (CTX-I)... CONCLUSION: Increased bioavailability of orally administered 0.8 mg sCT was highly correlated with increased suppression of the bone resorption marker serum CTX-I irrespective of the time of day. However, the high inter- and intraindividual variability in sCT exposure demonstrates the importance of determining the optimum conditions for ensuring the most beneficial sCT uptake.
Biochemical markers identify influences on bone and cartilage degradation in
osteoarthritis--the effect of sex, Kellgren-Lawrence (KL) score, body mass index
(BMI), oral salmon calcitonin (sCT) treatment and diurnal variation. 
oral salmon calcitonin (sCT) treatment and diurnal variation... CONCLUSION: Bone resorption was higher in females than males, while cartilage
The effect of oral salmon calcitonin delivered with 5-CNAC on bone and cartilage
degradation in osteoarthritic patients: a 14-day randomized study. 
days to men and women presenting with osteoarthritis (OA)... CONCLUSIONS: oSCT given twice daily with a pre-dinner and morning fasting dosing
Clinical Trials Related to Fortical (Calcitonin Nasal)
Effects of Water and Food Intake on the Pharmacokinetics and Pharmacodynamics of Oral Salmon Calcitonin in Healthy Postmenopausal Women [Completed]
This is a phase I study to analyze the effect of water and food intake on the bioavailability
and pharmacodynamic of oral salmon calcitonin (SMC021) and salmon calcitonin nasal spray in
Pharmacokinetics/Pharmacodynamics of Oral Salmon Calcitonin in Patients With Osteoarthritis [Completed]
The purpose of this study is to expose patients with OA to calcitonin and to determine plasma
calcitonin levels after administration of 0. 6 mg and 0. 8 mg oral calcitonin and 200 IU nasal
calcitonin. Also the purpose is to assess the effect of different doses of oral calcitonin
(0. 6 mg and 0. 8 mg oral) and 200 IU nasal calcitonin compared to placebo on serum CTX-I and
CTX-II. Finally to assess the tolerance profile of different doses/formulations of oral
calcitonin compared to placebo.
Efficacy and Safety of Salmon Calcitonin Nasal Spray in Improving Muscle Strength and Reducing Pain After Forearm Fracture in Postmenopausal Women [Completed]
Calcitonin has been used for many years for treating osteoporosis in postmenopausal women,
and it has been shown that calcitonin reduces pain after spine and hip fracture in women with
osteoporosis. Therefore, this study assesses the safety and efficacy of salmon calcitonin
nasal spray on muscle strength after a forearm fracture, pain, quality of life and fracture
healing in postmenopausal women.
A Study Comparing Oral Calcitonin to Nasal Spray Calcitonin in Postmenopausal Osteoporotic Women [Recruiting]
The purpose of this study is to compare the effectiveness and tolerability of two
medications, calcitonin nasal spray and a tablet containing calcitonin, in postmenopausal
women with osteoporosis. Osteoporosis is the term used to describe a large group of
diseases, which are characterized by loss of bone density, which makes the bones weaker.
Osteoporosis often occurs in postmenopausal women.
Calcitonin is a hormone found in the human body. Together with other substances, it
regulates the concentration of calcium in the blood and inhibits the natural resorption of
bone. Both medications in this study contain salmon calcitonin (sCT), because this form of
calcitonin is more active than human calcitonin when used as a medicine.
The calcitonin Nasal Spray used in this study is registered and available to doctors in
United States for the treatment of osteoporosis. The medication being tested in this study
is an oral tablet form of salmon calcitonin.
Analgesic Effect of Intranasal Calcitonin on Patients With Fractured Ribs [Terminated]
This study, which will be conducted at the emergency room of the Sacré-Cœur hospital,
requires the recruitment of 60 subjects and involves some telephone follow-up.
Calcitonin administered as an intranasal spray is already used to relieve pain caused by
broken vertebrae and we seek to determine if it can be as efficient in the case of pain
caused by broken ribs. This study aims at testing the hypothesis that subjects suffering from
the accidental fracture of one or more ribs will get relief through the intranasal spraying
of calcitonin and/or will use less opiate medication for pain relief (a combination of
oxycodone chlorhydrate and acetaminophen called Percocet®).
Reports of Suspected Fortical (Calcitonin Nasal) Side Effects
Hot Flush (3),
Back Pain (3),
Nasal Discomfort (2),
Musculoskeletal Stiffness (2),
Bone Density Decreased (2),
Rhinitis (2), more >>