Calcitonin

• Injection 400units/2ml

Indications and dose

• Hypercalcaemia of malignancy, adult over 18 years, by subcutaneous or intramuscular injection, 100units every 6–8 hours adjusted according to response; maximum 400units every 6–8 hours; in severe or emergency cases, by intravenous infusion, up to 10units/kg over at least 6 hours
• Paget's disease of bone, adult over 18 years, by subcutaneous or intramuscular injection, 50units 3 times weekly to 100units daily adjusted according to response; maximum duration of treatment 3 months (6 months in exceptional circumstances)
• Prevention of acute bone loss due to sudden immobility, adult over 18 years, by subcutaneous or intramuscular injection, 100units daily in 1–2 divided doses, reduced to 50units daily at start of mobilisation; duration of treatment 2 weeks, maximum 4 weeks

Notes

1. Short courses of calcitonin (e.g. three times a week for up to 3 months) may be considered for those patients with fragility fractures if alternative analgesics have been unsuccessful.

Abaloparatide

• Solution for injection 1.5ml pre-filled pens 80micrograms/40microlitres

Notes

1. NICE TA991: Abaloparatide (Eladynos) is recommended as an option for treating osteoporosis after menopause in women, trans men and non-binary people, only if they have a very high risk of fracture and the company provides it according to the commercial arrangement (August 2024).

Teriparatide

• Injection 250micrograms/ml

Notes

1. Prescribe by brand. A biosimilar medicine is a biological medicine that is highly similar and clinically equivalent (in terms of quality, safety, and efficacy) to an existing biological medicine however they cannot be considered generic equivalents of the originator biological medicine. Because they are not identical, biological medicines must be prescribed by brand. The decision which brand to prescribe rests with the responsible clinician in consultation with the patient. Automatic substitution of brands at the point of dispensing is not appropriate for biological medicines.
2. Teriparatide is available as Forsteo, and the biosimilar products Terrosa and Movymia. All products are the same strength and have the same licensed indications, however Forsteo is a disposable pen device whereas the two biosimilar products are re-usable pen devices with replaceable cartridges. Terrosa and Movymia cartridges must only be used with the same brand re-usable pen devices. Patients should receive training on how to use their specific device. Refer to the SPS In Use Product Safety Assessment Report for more information.
3. NICE TA161 (February 2018): Teriparatide is recommended as an alternative treatment option for the secondary prevention of osteoporotic fragility fractures in postmenopausal women when used in line with the NICE TA.
4. NHS England Clinical Commissioning Policy (August 2024): Teriparatide for Osteoporosis in Men (Adults)
   1. Teriparatide is recommended as an alternative treatment option for the secondary prevention of osteoporotic fragility fractures in men in line with the NHSE policy criteria.