Patient case (clinical description): A 55-year-old white woman comes for a routine checkup.  She has no significant medical history and does not use tobacco, alcohol, or illicit drugs.  The patient's only medication is an over-the-counter multivitamin.  Family history is notable for a hip fracture in her mother.  Blood pressure is 130/80 mm Hg and pulse is 112/min. She has occasional back pain and lives a sedentary lifestyle with the BMI of 24 Kg/m2. Plain X-ray of the spine shows mild compression fracture at the level of T10. X-ray absorptiometry studies demonstrate abnormally low bone density in the lumbar vertebrae and T-score values below -2.5, which confirms the diagnosis of osteoporosis.

Patient's own account: I'm a 55-year-old white woman and I recently visited my family doctor. I don't smoke anything or drink. I don't have any remarkable medical history. I only use over-the-counter multivitamins to keep myself fresh and energized. My mom had a hip fracture. The doctor took my blood pressure and it was 130/80 and my pulse was 112/min. I have annoying back pain from time to time and to be honest I don't exercise much or move much. My BMI is 24. I did a spine X-ray a while ago and my doctor showed me that I have a fracture on one of my vertebrae. I also have a low bone density in my lumbar vertebrae and T-score values below -2.5. The doctor diagnosed me with osteoporosis.

Clinical trial: A Study of Oral Recombinant Salmon Calcitonin (rsCT) to Prevent Postmenopausal Osteoporosis

Eligibility criteria:
Inclusion Criteria:

          -  Female and at least 45 years of age.

          -  Must have undergone the onset of spontaneous or surgical menopause more than 5 years
             prior to entry. Spontaneous menopause is defined as 12 months of spontaneous
             amenorrhea. Surgical menopause is defined as ≥ 6 weeks postsurgical bilateral
             oophorectomy with or without hysterectomy.

          -  Serum follicle-stimulating hormone (FSH) levels must be ≥ 30 mIU/mL.

          -  A body mass index (BMI) of not greater than 35 (BMI

             =weight [kg]/height[m]2).

          -  Bone mineral density (BMD) T-score between -1.0 and - 2.5 at the total hip, femoral
             neck, trochanter, or lumbar spine.

          -  Additional risk factors such that the 10 year risk of a major osteoporotic fracture or
             hip fracture risk is at least as great as a 65-year-old woman of the same race and BMI
             of 25 kg/m2 as determined by the FRAX algorithm .

          -  No clinically significant abnormal findings in the medical history or physical exam
             that would preclude participation in the investigator's opinion.

          -  No clinically significant abnormal laboratory values at the screening assessment.

          -  Subjects must give written informed consent after reading the Subject Information and
             Consent Form and having had the opportunity to discuss the study with the
             investigator.

        Exclusion Criteria:

          -  History of an osteoporotic fracture, defined as a fracture at the wrist, hip, or
             humerus occurring from a fall at standing height or less.

          -  BMD T-Score at any site ≤ -2.5.

          -  Current treatment (or within 3 months prior to randomization) with hormone replacement
             therapy.

          -  History of metabolic and other bone diseases, including osteogenesis imperfecta,
             osteomalacia, and Paget's disease.

          -  Vitamin D insufficiency defined as a 25 hydroxyvitamin D level < 20 ng/mL (50 nmol/L).

          -  Prior use of calcitonin, ever.

          -  Prior use of any bisphosphonate, ever.

          -  Prior use of denosumab, fluoride, or strontium, ever.

          -  Prior use of parathyroid hormone analogs, ever.

          -  Any condition or disease that may interfere with the ability to have a dual energy
             x-ray absorptiometry (DXA) scan or to evaluate a DXA scan, for example, severe
             osteoarthritis of the spine, spinal fusion, pedicle screws, history of vertebroplasty,
             or degenerative disease that results in insufficient number of evaluable lumbar
             vertebrae, bilateral hip replacements.

          -  Use of anabolic steroids or androgens within 6 months preceding randomization.

          -  Use of vitamin D metabolites and analogs, (e.g., calcitriol) within 3 months preceding
             randomization). Note: Vitamin D supplementation is not exclusionary.

          -  Use of estrogen or estrogen-related drugs (including selective estrogen receptor
             molecules), for example, tamoxifen, tibolone, or raloxifene within 3 months preceding
             randomization.

          -  Chronic systemic treatment with glucocorticoids.

          -  Clinically relevant abnormal history, physical findings, or laboratory values at the
             pre-study screening assessment that could interfere with the objectives of the study
             or the safety of the subject.

          -  Presence of acute or chronic illness or history of chronic illness which, in the
             judgment of the investigator, makes participation in the study medically
             inappropriate.

          -  Known acquired immune deficiency syndrome (AIDS) or human immunodeficiency virus (HIV)
             seropositivity.

          -  Uncontrolled hypertension, significant gastrointestinal abnormalities, uncontrolled
             diabetes mellitus, significant coronary heart disease, any psychotic mental illness,
             chronic allergic rhinitis, asthma, uncorrected endocrine dysfunction, or significantly
             impaired hepatic, respiratory, or renal function.

          -  Participation in any other clinical study within the previous month.

          -  History of drug or alcohol abuse, or intake of more than 30 units of alcohol weekly.

          -  Possibility that the subject will not cooperate with the requirements of the protocol.

          -  Known sensitivity to sCT.

          -  Shift workers-individuals who are at work during overnight hours.
Female
No healthy subjects accepted to join the trial.
Subject must be at least 45 Years old.


Eligibility (NLI label): Contradiction