title: Combination therapy for osteoporosis: considerations and controversy.
abstract: Combination therapy, the simultaneous use of two pharmaceutical agents with the goal being reduction of fracture risk, is an area of substantial clinical interest. This paper summarizes the rationale, existing clinical trials data, and other considerations relevant to combination therapy for osteoporosis. Combinations of antiresorbers (eg, estrogen plus bisphosphonates) produce greater increases in bone mass than either treatment alone. Conversely, combining anabolic agents (parathyroid hormone) with bisphosphonates does not produce additive effects. None of the existing studies are large enough to determine whether combination treatment reduces fracture risk to a greater extent than use of a single agent. However, it is certain that combination treatment will increase cost and likely that it will increase side effects and reduce therapy adherence. Given the absence of demonstrated fracture reduction benefit, increased cost and likely increase in adverse events, combination therapy is not currently recommended.
authors.affiliation: University of Wisconsin-Madison, Osteoporosis Clinical Center and Research Program, 2870 University Avenue, Suite 100, Madison, WI 53705, USA. nbinkley@facstaff.wisc.edu
authors.forename: Neil
authors.initials: N
authors.lastname: Binkley
authors.forename: Diane
authors.initials: D
authors.lastname: Krueger
mesh_terms: D019386:Alendronate / Q000494:pharmacology / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001862:Bone Resorption / Q000188:drug therapy; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D045166:Estradiol Congeners / Q000627:therapeutic use; D006801:Humans; D010012:Osteogenesis / Q000187:drug effects; D010024:Osteoporosis / Q000188:drug therapy*; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D045166:Estradiol Congeners; D020845:Selective Estrogen Receptor Modulators; D019386:Alendronate