Does Calcitonin (salmon) help with vertebral fracture risk? Grade A evidence

What the studies show

PROOF: the 200 IU dose reduced new vertebral fractures by 33%, but the 100 and 400 IU doses did not — no dose–response, and a trial with 60% dropout. Regulators later judged the benefit marginal.

“The 200-IU dose of salmon calcitonin nasal spray significantly reduced the risk of new vertebral fractures by 33% compared with placebo [200 IU: 51 of 287, placebo: 70 of 270, relative risk (RR) = 0.67, 95% confidence interval (CI): 0.47- to 0.97, P = 0.03].”

Verbatim, from the abstractChesnut CH 3rd, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence Of Osteoporotic Fractures study (PROOF). Am J Med, 2000;109:267–276

Several well-run randomised trials in people, pointing the same way. You can plan around this. It still says nothing about whether the effect is worth the side effects for you.

1
Chesnut CH 3rd, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence Of Osteoporotic Fractures study (PROOF).Am J Med, 2000;109:267–2761,255 women, 5 years; 511 completed.

In context

Calcitonin is a thyroid hormone that lowers blood calcium by slowing bone breakdown; the salmon version, more potent than human, was sold for decades as an osteoporosis nasal spray. Its one large fracture trial found a 33% reduction in spinal fractures at the middle dose and none at the higher one. In 2012–2013 European and other regulators withdrew the nasal spray after meta-analyses found a small excess of cancers, leaving short-term injectable use for Paget's disease and hypercalcaemia.

Calcitonin (salmon) is approved (rx, restricted). Legal status differs by country — see the regulation section or the jurisdiction pages.

Questions

Is Calcitonin (salmon) proven to help with vertebral fracture risk?

Yes, as far as human trials can show it: 1 large RCT (n=1,255, 5 yr). LYO grades this outcome A.

What studies are behind the grade?

PROOF: the 200 IU dose reduced new vertebral fractures by 33%, but the 100 and 400 IU doses did not — no dose–response, and a trial with 60% dropout. Regulators later judged the benefit marginal.

Is Calcitonin (salmon) approved for this?

Calcitonin (salmon) is an approved medicine (Approved (Rx, restricted)); whether this particular outcome is a licensed indication is stated on the compound page's regulation section.

Other outcomes for Calcitonin (salmon)

ADose–responseSame RCT
BCancer risk (long-term use)adverseRegulatory meta-analyses of RCTs
APaget's disease and acute hypercalcaemiaDecades of use; older trials

Written and maintained by LYO Research — how pages are written and checked. Reviewed 23 September 2026. Grades count human evidence only; see how LYO grades. Not medical advice. Correct this page →