The use of combination therapy in the treatment of postmenopausal osteoporosis.
In recent years, there has been growing interest in the potential use of combination therapy in the management of osteoporosis in postmenopausal women. Possible regimens include sequential or combined use of anti-resorptive drugs or combinations of anabolic and anti-resorptive agents, given concurrently or in sequence. Combined therapy with anti-resorptive drugs usually produces greater increases in bone mineral density (BMD) than monotherapy but there is no evidence that this results in greater anti-fracture efficacy. The use of bisphosphonates before strontium ranelate or PTH peptides blunts the BMD response. Combined PTH and anti-resorptive therapy results in more rapid gains in spine BMD and a greater increase in hip BMD than PTH monotherapy in the first year of treatment but greater gains in both spine and hip BMD are seen with PTH monotherapy than combined therapy after 2 years of treatment. Anti-resorptive therapy after PTH therapy maintains or increases the gains in BMD. Further research is required to establish the cost-effectiveness and safety of combined and sequential regimens.
Bone Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK. jec1001@cam.ac.uk
Juliet
J
Compston
D000368:Aged; D000369:Aged, 80 and over; D045930:Anabolic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008875:Middle Aged; D009942:Organometallic Compounds / Q000494:pharmacology / Q000627:therapeutic use; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000494:pharmacology / Q000627:therapeutic use; D013876:Thiophenes / Q000494:pharmacology / Q000627:therapeutic use
D045930:Anabolic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009942:Organometallic Compounds; D010281:Parathyroid Hormone; D013876:Thiophenes; C081587:strontium ranelate