Calcitonin
Overview
A 32-amino acid peptide hormone naturally produced by parafollicular C-cells of the thyroid gland. Calcitonin inhibits osteoclast-mediated bone resorption by binding to calcitonin receptors on osteoclasts, reducing their activity and number. Salmon calcitonin is approximately 40-50 times more potent than human calcitonin and has a longer half-life, making it the preferred therapeutic form.
Key Research Findings
FDA-approved for postmenopausal osteoporosis, Paget's disease, and hypercalcemia. PROOF trial demonstrated 33% reduction in vertebral fractures with nasal calcitonin 200 IU daily. Has analgesic properties for acute vertebral compression fractures independent of its anti-resorptive effects. Use has declined due to availability of more potent anti-resorptive agents and a small signal of increased malignancy risk with long-term use.
Intranasal, Subcutaneous injection, Intramuscular injection
FDA Approved
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Teriparatide (Forteo)
FDA ApprovedA recombinant form of the first 34 amino acids of human parathyroid hormone (PTH 1-34). When administered intermittently via daily subcutaneous injection, teriparatide stimulates osteoblastic bone formation more than osteoclastic resorption, producing a net anabolic effect on bone. It activates the PTH1 receptor on osteoblasts, increasing Wnt signaling, osteoblast differentiation, and survival while reducing sclerostin expression.
Abaloparatide (Tymlos)
FDA ApprovedA synthetic 34-amino acid peptide analog of parathyroid hormone-related protein (PTHrP 1-34) that selectively activates the RG conformation of the PTH1 receptor. This receptor selectivity produces a more transient signaling response compared to teriparatide, favoring anabolic bone formation with less stimulation of bone resorption and calcium mobilization. Abaloparatide increases bone mineral density at both cortical and trabecular sites.
Vosoritide (Voxzogo)
FDA ApprovedA C-type natriuretic peptide (CNP) analog that acts as an agonist at the natriuretic peptide receptor B (NPR-B) on growth plate chondrocytes. Vosoritide counteracts the constitutively activated FGFR3 signaling that suppresses endochondral ossification in achondroplasia. By stimulating the NPR-B/cGMP/MAPK pathway, it antagonizes the growth-inhibitory FGFR3 signal and restores more normal linear bone growth.