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Effects of intranasal salmon calcitonin in juvenile idiopathic arthritis: an observational study
A Siamopoulou1, A Challa, P Kapoglou
1Child Health Department, Medical School, University of Ioannina, Greece.
Insights
Salmon calcitonin therapy in children with juvenile idiopathic arthritis (JIA) showed potential benefits for bone health. The treatment reduced bone resorption markers and improved bone mineral density over three years.
Area of Science:
- Pediatric Rheumatology
- Endocrinology
- Bone Metabolism
Background:
- Juvenile idiopathic arthritis (JIA) can lead to significant bone health issues in children.
- Assessing the long-term effects of therapeutic interventions on bone turnover is crucial for managing JIA.
Purpose of the Study:
- To evaluate the impact of salmon calcitonin and calcium supplementation on bone mineral density (BMD) and bone turnover markers in children with severe JIA over a 3-year period.
Main Methods:
- A cohort of 10 children (7.5-17.5 years) with severe JIA (functional classes III-IV) received salmon calcitonin (100-200 IU/day) and calcium (500 mg/day).
- Bone mineral density (BMD) was measured annually using dual photon absorptiometry at the lumbar spine.
- Biochemical markers of bone turnover, including resorption and formation markers, were analyzed.
Main Results:
- Significant annual increases in BMD (7.2-9.5%) and volumetric BMD (BMDvol, 2.0-6.0%) were observed.
- Bone resorption markers (Pyr/Cr, Pyr-D/Cr, OHPr/Cr) decreased significantly after one year (P < 0.001 for Pyr/Cr).
- No significant changes were noted in bone formation markers (osteocalcin, alkaline phosphatase); calcium excretion increased significantly (P < 0.001).
Conclusions:
- Intranasal salmon calcitonin, combined with calcium, may offer beneficial effects on bone resorption and potentially pain relief in pediatric patients with JIA.
- The study highlights the need for further placebo-controlled trials to confirm these findings in JIA management.
Abstract:
The aim of this study was to follow the changes in bone mineral density (BMD) and biochemical markers of bone turnover in 10 children (7.5-17.5 years of age) with severe juvenile idiopathic arthritis (JIA), during a 3-year therapy with salmon calcitonin (100 IU/day 2 months on and 2 off for a year and 200 IU/day for 2 years) and calcium (500 mg/day). All patients were functional classes III and IV and were measured at yearly intervals with a dual photon absorptiometer at the lumbar spine. The changes observed were 7.2-9.5% per year for BMD and 2.0-6.0% for volumetric bone mineral density (BMDvol). The bone resorption markers showed significant decreases after a year's treatment (Pyr/Cr from 175+/-15 to 108+/-15 nm/mm, P < 0.001, Pyr-D/Cr from 24.3+/-3.5 to 13.3+/-1.9 nm/mm, P < 0.05, and OHPr/Cr from 57.4+/-11 to 35.1+/-8.4 microg/mg) and smaller changes thereafter. No significant changes were observed in the bone formation markers of osteocalcin and alkaline phosphatase. Serum iPTH, the vitamin D metabolites, and calcium concentrations fluctuated within normal, while calcium excretion increased from 0.3+/-0.1 to 1.9+/-0.4 mg/kg/24 hours, P < 0.001. In conclusion, the present study, despite its limitations of not being placebo controlled, shows possible beneficial effects of intranasal calcitonin on bone resorption and pain relief in JIA patients.
