Q: I’ve read in your columns about Atelvia, Actonel, Fosamax and Boniva for osteoporosis but never anything about Fortical. It is a nasal spray used once a day and was recently prescribed by my physician. It seems to have few side effects but is it as effective as the other medications?
A: Osteoporosis occurs when the normal buildup and breakdown of minerals in healthy bone fall out of balance. When the loss is greater than the gain, low bone mass results. The average individual begins to lose bone strength by the time he or she is in the mid 30s. Of the millions of men and women diagnosed with osteoporosis, post-menopausal women head the list, followed by people with small frames, those that lead a sedentary lifestyle, are on corticosteroids, or diagnosed with hyperthyroidism and rheumatoid arthritis.
Fortical is a polypeptide hormone used to prevent and treat osteoporosis. The active ingredient in the product is calcitonin-salmon, a manufactured form of the hormone calcitonin that occurs naturally in the thyroid gland. It is available both as an injectable and as a nasal spray. The injectable form treats osteoporosis, Paget’s disease and seriously elevated blood calcium levels, while the nasal form is used for osteopenia and is licensed for women diagnosed with osteoporosis who have been post-menopausal for at least five years. The nasal form should be used in conjunction with calcium and vitamin D and will be discussed here since this is what you have been recommended. According to some researchers, the nasal form is less popular because of its relatively modes effect on bone mineral density and weak anti-fracture efficacy compared with bisphosphonates and parathyroid hormone.
Side effects are generally uncommon or mild but may occur and might include severe nasal irritation, tremors, and a feeling of passing out. Less serious issues include epistaxis (nose bleeds), headache, back pain, nausea, a runny or stuffy nose, tremors, redness in and around the nose, dryness/itching/tenderness/general discomfort of the nose, and crusting lesions inside the nose.
There are several drugs known to interact with Fortical. Some of the more common medications are Tagamet (cimetidine), and morphine; however herbals, vitamin and other over-the-counter products should be reported to your physician prior to beginning the medication.
Calcitonin-salmon is a protein, implying a systemic allergic reaction can exist. As such, your physician may choose to perform an allergy skin test prior to prescribing your first dose of Fortical Nasal Spray. As such, he or she should be informed of any nasal deformities, nasal pain, chronic infection or other sinus problems you may have. The spray will deliver a fine mist into the nose and is good for 30 sprays. At the end of the 30 sprays, the dispenser should be discarded, even if medication remains in the bottle. Fortical is sprayed into one nostril only daily, rotating the next day to the opposite side. Other nasal sprays you may be on should be discontinued unless you have been given the okay by your physician to continue them.
Following menopause, the rate of bone loss accelerates. Fortical is not intended to prevent osteoporosis, but rather acts as a treatment that works by slowing bone loss and reducing a person’s risk of bone fracture. Lifestyle changes can also go a long way toward promoting healthy bones. Individuals should limit alcohol intake, discontinue smoking, eat well-balanced meals containing calcium and vitamin D, and stay active by exercising as much as allowed based on pother possible medical conditions.
I wish I could answer your question regarding Fortical but I do not have access to your medical records and don’t know what other conditions you might have or what medications you may be on. I do not know how severe your osteoporosis is. Some medications for osteoporosis are associated with an increased risk of femur fractures. Selective estrogen receptor modulators can increase the risk of developing blood clots, and hormone therapy can increase the risk of heart attack, stroke and uterine cancer, so it’s a tough call. I can only recommend you speak in depth with your physician and perhaps even get a second opinion before making the decision. In the interim, eat well, take calcium with vitamin D, and exercise.
Readers who would like related information can order Dr. Gott’s Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.