Intranasal complications in women with osteoporosis under treatment with nasal calcitonin spray: Case reports and review of the literature

Objective To describe the nasal side effects of postmenopausal women suffering from osteoporosis and being treated with intranasal calcitonine (InC). Method Two women who presented with nasal complaints, were diagnosed as having nasal septum perforation and septum-concha inferior synechiae respectively. Both were receiving treatment with InC for postmenopausal osteoporosis. A medline search for similar side effects of InC revealed a range of nasal symptoms and several factors that could induce these symptoms. Results Exclusion of other causative conditions leads us to attribute the nasal findings to the use of InC. The literature mentions mild and usually reversible side effects from use of InC. Substances included in the calcitonine spray (preservatives, accelerators of absorption), the development of antibodies against the hormone and possible implication of coexisting diseases or medications to the provocation of nasal side effects, are discussed. Conclusions Intranasal administration of calcitonine is an established therapy for postmenopausal osteoporosis and other skeletal diseases. The side effects from its use are commonly local, mild and transient, but there is not sufficient information on how this process begins. An ENT examination before and during therapy with InC would be beneficial to patients for the recognition and prevention of serious side effects.