Revisiting Intranasal Salmon Calcitonin: Historical Osteoporosis Evidence and a Potential Role in Acute Orthopaedic Pain Management

» Intranasal salmon calcitonin (IN-CAL) is a well-tolerated, noninvasive antiresorptive agent with reproducible pharmacodynamic activity, despite lower systemic bioavailability than parenteral formulations. » In preosteoporotic postmenopausal women, IN-CAL provides small, spine-limited preservation of bone mass, with minimal hip or forearm benefit; treatment response depends more on baseline bone turnover than on dose escalation. » In established postmenopausal osteoporosis, IN-CAL produces early biochemical suppression (1-3 months) and small but consistent lumbar spine bone mineral density (BMD) gains with sustained therapy (≥6-12 months). » IN-CAL is less effective than bisphosphonates and modern anabolic agents for increasing BMD and reducing fracture risk; accordingly, its use is best reserved for patients who cannot take first-line therapies due to contraindications, intolerance, or personal preference. » IN-CAL provides short-term pain relief for vertebral fractures in osteoporosis and offers a similarly time-limited analgesic benefit in acute orthopaedic settings, with pain reduction often within days and biochemical or skeletal effects evolving over subsequent weeks.