Parenteral salmon calcitonin (Calcimar®): reduces osteoclastic activity directly, osteoblastic hyperactivity subsides secondarily. Relapse may occur even while on calcitonin. Side effects include nausea, facial flushing, and the development of antibodies to salmon calcitonin (these patients may benefit from a more expensive synthetic human preparation (Cibacalcin®) starting at 0.5 mg SQ q d).

50–100 IU (medical research council units) SQ q d × 1 month, then 3 injections per week for several months.

If used pre-op to help decrease bony vascularity, ≈ 6 months of treatment is ideal. Doses as low as ≈ 50 IU units 3 ×per week may be used indefinitely post-op or as a sole treatment (alkaline phosphatase and urinary hydroxyproline decline by 30–50% in > half of patients in 3–6 months, but they rarely normalize).