Salmon Calcitonin
Bone / OsteoporosisAlso known as: sCT, Miacalcin, Fortical, Calcimar, Calcitonin-Salmon
Mechanism
Salmon calcitonin is a 32-amino-acid peptide used to treat osteoporosis and Paget's disease of bone. The salmon form is 40-50 times more potent than human calcitonin because of its greater receptor binding affinity. It works by directly inhibiting osteoclasts (bone-resorbing cells), slowing bone loss. Available as a nasal spray (Miacalcin, Fortical) or injection, it also has analgesic effects for bone pain.
Technical detail
Salmon calcitonin (sCT) is a 32-amino-acid peptide with a disulfide-bridged N-terminal ring, differing from human calcitonin at 16 positions. These substitutions confer higher CTR binding affinity and resistance to degradation, resulting in 40-50x greater potency. It activates the calcitonin receptor (CTR, Gs-coupled) on osteoclasts, increasing cAMP-PKA signaling which disrupts the osteoclast ruffled border, inhibits carbonic anhydrase II and cathepsin K, and induces osteoclast quiescence. Net effect is reduced bone resorption. Analgesic properties may involve central serotonergic mechanisms and beta-endorphin release. Nasal bioavailability is approximately 3-5%.
Evidence
- moderate
Hu et al. (2024) — Journal of Nutritional Science and Vitaminology — PMID: 39477477
In 88 post-operative lumbar fracture patients, adjunct salmon calcitonin improved pain, bone turnover markers, disability scores, and activities of daily living versus calcium/vitamin D alone over 3 months without major safety signals.
- moderate
Roy et al. (2021) — Journal of Cranio-Maxillofacial Surgery — PMID: 34593298
Post-operative salmon calcitonin nasal spray was associated with lower pain scores, higher osteocalcin, and better radiographic healing in mandibular fracture patients after ORIF.
- moderate
Three-Month Randomized Clinical Trial of Nasal Calcitonin in Adults with X-linked Hypophosphatemia
Sullivan et al. (2018) — Calcified Tissue International — PMID: 29383408
Daily nasal salmon calcitonin was studied in adults with X-linked hypophosphatemia after prior signal that calcitonin could transiently lower FGF23; useful as human endocrine and bone evidence even though effects were condition-specific.
- moderate
Karponis et al. (2015) — Journal of Musculoskeletal & Neuronal Interactions — PMID: 26032211
Among postmenopausal women with recent distal radius fracture, intranasal salmon calcitonin produced a greater early reduction in pain scores than placebo during the first post-fracture period.