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Calcitonin load test to assess the efficacy of salmon calcitonin
1Department of Internal Medicine 3, Faculty of Medicine 1, Charles University, U nemocnice 1, CZ-128 00, Prague, Czech Republic. jstephan@mbox.vol.cz
Background:
Monitoring treatments of osteoporosis is required to identify patients not responding to the treatment in a way that reflects mechanism of action of the antiresorption drug on bone. Neither bone mineral measurement nor the available biochemical markers of bone remodeling can be used to monitor efficacy of treatment with nasal spray salmon calcitonin (sCT) since the changes in individual patients are modest and do not exceed the least significant change.
Method:
The novel calcitonin load test (CLT) was developed to assess the biological response to sCT in postmenopausal osteoporotic women. The CLT is based on the time course and an extent of suppression of serum C-terminal telopeptide of types I collagen (CTX) after the intranasal and subcutaneous administration of sCT. The CLT was conducted in 30 untreated postmenopausal osteoporotic women (control group, mean age, 67.7+/-8.4 years), and in 120 postmenopausal osteoporotic women (mean age, 68.5+/-8.1 years) treated with 200 IU of sCT (Miacalcic Nasal, Novartis, Switzerland), for up to 8.4 years (mean, 3.5+/-2.1 years).
Results:
After 90 min from the intranasal administration of 400 IU of sCT, a decrease (p<0.01) in serum CTX by 58+/-11% was found in the control group, and by 60+/-11% in 74% of the treated patients. In the remaining treated patients, the decrease in CTX did not exceed the least significant change. The number of patients not responding to the CLT increased with duration of the treatment up to 34% in patients treated for over 4 years. Of the non-responders to the nasal spray sCT, 63% failed to respond to the subcutaneous administration of 10 IU of sCT. In the treated group, a significant negative correlation has been found between the percentual changes in CTX from its baseline levels detected during the CLT, and a rate of changes in the femoral neck BMD (p<0.01).
Conclusion:
The CLT can be used as a tool to identify patients that respond to administration of CT, and will profit from a continued treatment with sCT.
Insights
A novel calcitonin load test (CLT) effectively identifies osteoporosis patients responding to salmon calcitonin (sCT) treatment. This method assesses biological response by measuring serum C-terminal telopeptide of type I collagen (CTX) suppression.
Area of Science:
- Endocrinology
- Bone Metabolism
- Pharmacology
Background:
- Monitoring osteoporosis treatment efficacy is crucial for patient management.
- Current bone mineral density and biochemical markers are insufficient for assessing response to nasal salmon calcitonin (sCT).
- Existing methods do not adequately reflect the antiresorptive mechanism of sCT.
Purpose of the Study:
- To develop and validate a novel calcitonin load test (CLT) for monitoring sCT treatment response.
- To assess the biological response to sCT in postmenopausal osteoporotic women.
- To identify patients who may not benefit from continued sCT therapy.
Main Methods:
- The calcitonin load test (CLT) was developed, measuring serum C-terminal telopeptide of type I collagen (CTX) suppression after sCT administration.
- The study included 30 untreated women (control) and 120 treated postmenopausal osteoporotic women.
- Both intranasal and subcutaneous sCT administration were used to evaluate CTX response.
Main Results:
- Intranasal sCT induced significant CTX suppression in controls and 74% of treated patients.
- A notable percentage of treated patients (up to 34% after 4 years) showed minimal CTX decrease, indicating non-response.
- Non-responders to nasal sCT also frequently failed to respond to subcutaneous sCT, suggesting a genuine lack of biological effect.
Conclusions:
- The calcitonin load test (CLT) is a viable tool for identifying patients who respond to calcitonin (CT) therapy.
- CLT can help determine which patients will benefit from continued treatment with nasal spray salmon calcitonin (sCT).
- This test aids in personalized osteoporosis management by revealing treatment responsiveness.
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