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The second major medication for preserving and increasing bone density is calcitonin (brand name Miacalcin). Calcitonin is a natural hormone made by the thyroid gland that limits the release of calcium from bones into the blood. Levels in the body generally decrease with age, and estrogen stimulates the secretion of it; menopause, with markedly decreased levels of estrogen, causes even lower levels. Low bodily calcitonin does not indicate low bone density, but prescription calcitonin can help protect bones. What you get in a prescription, though, is actually from salmon because it is fifty to a hundred times stronger than human calcitonin. Like estrogen and bisphosphonates, calcitonin acts to slow bone breakdown.Over three-quarters of the patients who use calcitonin will see increases in their bone density. Studies show gains of over 3 percent a year in bone density after two years of taking calcitonin, in most—but not all—patients, and a 40 percent reduction in risk of fractures in the spine. So my patient was ahead of the curve—a plug for adopting a healthy lifestyle to maximize the results of drug treatment. Even if there is no gain but there is also no loss, calcitonin is beneficial. It works best in men, and women more than five years after menopause and hence no longer in the accelerated phase of bone loss, and it may be more effective in the spine than other parts of the skeleton. (Although I’m convinced we’ll eventually find out that it is equally effective all over the body, and I use it as if it is.) Calcitonin is not yet proven to decrease the rate of fractures.Calcitonin is the best choice for those who do not take estrogen and who cannot tolerate alendronate. Calcitonin, unlike other treatment options, can help control bone pain, although we don’t know why. So it may also be the best choice for those in pain from vertebral fractures. More studies have been done on alendronate than on calcitonin, so it is most doctors’ first recommendation. But given the safety record of and lack of side effects associated with calcitonin, I usually recommend starting with that. I’m betting that as more studies are completed, calcitonin will be shown to equal or even surpass alendronate in overall effectiveness, especially in women not taking HRT. My stance Is slightly against the current, but I’m a believer in giving calcitonin a chance to work as long as there is time to play with, because it is the safest and most physiologically natural choice when a prescription is required.For years, the only way to get calcitonin was by injection several times a week, but now a nasal spray makes using it much simpler (not to mention more appealing). The usual dose is 200IU, sprayed in alternating nostrils daily. About 10 percent of patients experience nasal dryness and irritation. Calcitonin must be kept refrigerated. You should take supplements of calcium and vitamin D to maximize the effectiveness. Calcitonin is considered very safe, since it has been used (in the injectable form) for over twenty years to treat bone disease without any significant problems.*156\228\2*

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