Effects of synthetic salmon calcitonin in patients with Paget's disease of bone

Sixteen patients with symptomatic, metabolically active Paget's disease of bone received a single daily injection of synthetic salmon calcitonin for 3 to 20 months (average, 9 months). Elevations of serum alkaline phosphatase or urinary hydroxyproline levels were reduced in 14 of 16 patients and became normal in 4 of 16. Chemical evidence of resistance to calcitonin developed in 2 of 16 patients and may have correlated with phosphate depletion. Oral phosphate therapy appeared to improve the response to calcitonin. Bone pain caused directly by Paget's disease was ameliorated in 12 of 13 patients, but pain resulting from skeletal deformity or mechanical stress was not alleviated. No significant side effects of calcitonin therapy were noted. Salmon calcitonin is effective in the treatment of selected patients with Paget's disease of bone.