Is there a role for combination therapy for osteoporosis?

摘要

There is no single agent currently available that represents a cure for osteoporosis. Various anabolic and antiresorptive therapies have been combined, following different protocols, to attempt to attain superior bone mass and strength compared to monotherapy. There is a great deal of misunderstanding about results of these trials. The small randomized, blinded study in men with osteoporosis in this issue of the journal 1, evaluating a previously untested combination of teriparatide and risedronate compared with either agent alone, might help encourage some reconsideration of combination therapy for treatment of osteoporosis. In trying to interpret the many different combination therapy studies 2, 3, it is important to make some distinctions between the populations that have been studied: previously untreated individuals receiving two agents concomitantly and individuals on established antiresorptive therapy where the anabolic agent is combined with continued antiresorptive therapy. While there are some parallels between these two populations, differences in the magnitude of active bone surface, effects of acute antiresorptive agents on parathyroid dynamics, and perhaps unique acute effects of antiresorptive agents on osteoblast function might all play a role in producing distinct responses to combination therapy in previously treated vs treatment naive individuals. A third population of individuals who have been on prior bisphosphonates in the recent or remote past has not been adequately studied.