The Osteoporosis Medication Center

Osteoporosis is a disease associated with a gradual thinning and weakening of the bones. It occurs most frequently in women who have gone through menopause. Some women experience menopause naturally, others undergo surgically induced menopause.

In either case, after menopause, a woman’s body undergoes changes. One change is that her body slowly stops producing estrogen—a hormone that helps keep bones strong. Without it, bones may become weak. As bones become thinner and weaker, they become increasingly susceptible to fractures. Over the course of time, tiny bone fractures in the spine can lead to stooped posture and loss of height. If left untreated, postmenopausal osteoporosis can lead to constant back pain, disabling fractures, and lost mobility.

One way to help find out if you may be at risk for postmenopausal osteoporosis is to answer the following 6 basic questions:

• Are you past menopause?

• Are you shorter than you once were?

• Are your shoulders more rounded?

• Is your back in constant pain?

• Have you recently broken a bone?

• Have these things happened to women in your family?

If you answered "yes" to any of these questions, it is a good idea to talk about postmenopausal osteoporosis with your doctor or healthcare provider during your next office visit. Only your doctor can determine if you have osteoporosis after menopause.

If you find out that you have postmenopausal osteoporosis, your doctor or healthcare provider can develop a plan that can help you keep your bones as strong as possible. This plan may include having you start a regular exercise routine, make important changes in your diet and your lifestyle, take vitamins and supplements, and possibly initiate a medication regimen that can help you keep your bones strong.

It’s true that your body needs 1000 to 1500 mg of calcium and 400 to 800 IU (international units) of vitamin D every day in order to help maintain bone strength. While it is important to get the necessary amounts of calcium and vitamin D every day, they’re not enough to successfully treat postmenopausal osteoporosis. The good news is: Osteoporosis after menopause can be treated. To help keep bones as strong as possible, healthcare providers can now prescribe several prescription medications that successfully treat postmenopausal osteoporosis. One convenient treatment is MIACALCIN^® (calcitonin-salmon) Nasal Spray (pronounced MEE-uh-CAL-sin).

MIACALCIN Nasal Spray is a prescription medication recommended for the treatment of postmenopausal osteoporosis in women more than 5 years after menopause who have low bone mass, and who can’t or won’t take estrogens, or for whom estrogens are not an option. MIACALCIN Nasal Spray should be used along with adequate amounts of calcium and vitamin D every day.

Yes. Calcitonin, the active ingredient in MIACALCIN Nasal Spray, has been proven to stop bone loss and increase the density, or thickness, of bone in women who have postmenopausal osteoporosis.

MIACALCIN is approved for the treatment of postmenopausal osteoporosis in more than 70 countries, and the nasal spray was launched in the United States in late 1995. Based on more than 20 years of clinical trials in the United States and abroad, its active ingredient, calcitonin-salmon, has been shown to be an effective treatment for postmenopausal osteoporotic women.

A nasal spray is an effective way to treat osteoporosis—especially for patients who have problems using other types of medications. There are several benefits to using a nasal spray to treat postmenopausal osteoporosis, including:

The medicine from a nasal spray enters the bloodstream rapidly. That’s because the tiny blood vessels lining the nasal passages quickly absorb the fine mist of medication that is sprayed in the nostril. Then the medication goes right into the bloodstream, where it works to stop bone loss and helps bones become stronger. Other medications that have to be swallowed, such as tablets and pills, must first be absorbed by the digestive system.

The medicine from a nasal spray does not enter the stomach. MIACALCIN Nasal Spray is unlikely to cause unpleasant side effects such as discomfort of the stomach or esophagus, or other problems in the digestive system.

Using MIACALCIN Nasal Spray is easy and convenient because it can be used before, during, and after meals and with other medications. There’s no need to wait for long periods of time before eating, drinking, or taking other medications. Other treatments may have limits on when a patient can eat, drink, and take other medications. These strict rules may be difficult for some people to follow.

Unlike most nasal sprays, MIACALCIN Nasal Spray doesn’t have to be inhaled. It delivers a gentle spray that is barely noticeable—and the recommended dose is one spray, once a day.

As with any medication, some side effects can occur when using MIACALCIN Nasal Spray. Side effects may include: nasal symptoms (runny nose, crusting, nosebleed, etc), back and/or joint pain, and headache. These side effects tend to be mild and disappear quickly; however, in some cases, the doctor or healthcare provider may recommend temporarily discontinuing the medication until symptoms stop.

If people experience side effects after using MIACALCIN Nasal Spray, they should contact their healthcare providers. Also, because calcitonin-salmon is a protein, the potential for a systemic allergic reaction exists. People who are allergic to calcitonin-salmon should not use this medication.

Before opening the bottle, remove it from the refrigerator and allow it to reach room temperature. Lift up the blue plastic tab and carefully pull the seal off the bottle. Keeping the bottle upright, remove its rubber stopper. Then, holding the pump unit, remove the opaque plastic protective cap from the bottom of the unit. (Note: Do not depress pump when it is not attached to the bottle.)

Now, you’re ready to assemble. Holding the bottle upright, insert the nasal spray pump unit into the bottle, then turn the pump clockwise and tighten it until it is securely fastened to the bottle. Holding the bottle upright with the index finger on top of 1 of the 2 side arms of the pump, gently remove the clear protective cap from the top of the nozzle.

MIACALCIN Nasal Spray only needs to be primed the first time you use it. To prime, hold the bottle upright with the index fingers on the 2 side arms of the pump and the thumb on the bottom of the bottle. Press the arms down fully until there is a full spray. Once you see a full spray come out, the nasal spray is ready for use. There is no need to prime the bottle again; this will waste the medication.

• MIACALCIN Nasal Spray is dispensed in a fine mist—even if patients can’t feel it, it’s being absorbed

• Prime the bottle only once—when it is first opened and assembled

– The pump should not be re-primed before each daily use as this will waste the

medication

• Each metered-dose spray offers the proper amount of medication—200 IU per spray

– At least 2 weeks’ supply is included in each bottle

– Extra medication has been included to accommodate the initial priming

• Store unopened bottles in the refrigerator—not the freezer
• Opened bottles in use should be stored upright at room temperature—(not to exceed 77° F [25° C])

– The protective cap should be on the bottle whenever it is not in use

– A bottle should not be stored on its side or in its plastic tray after it has been

assembled or it may need to be re-primed

• Discard all unrefrigerated bottles after 30 days—whether opened or unopened

– Refrigerated bottles are good until the expiration date stamped on the bottle and box

• Clean the unit regularly—to help keep it sanitary

– Once or twice a week, the nozzle should be wiped with a clean, damp cloth, then

dried before replacing the protective cap