The use of combination therapy in the treatment of postmenopausal osteoporosis.
ABSTRACT 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.
- SourceAvailable from: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: To evaluate the responses of C-terminal telopeptide (CTX) and serum osteocalcin after the first 4 months of treatment with strontium ranelate (SR) and demonstrate their association with long-term bone density changes.Clinical medicine insights. Endocrinology and diabetes. 01/2014; 7:7-11.
- [Show abstract] [Hide abstract]
ABSTRACT: Osteoporosis is a disorder in which there is a net bone loss and microarchitectural deterioration with an increased risk of bone fracture because of uncoupling of bone formation and bone resorption. The treatment of osteoporosis aims to inhibit bone resorption by osteoclasts and/or promote bone formation by osteoblasts. However, most of the current approaches for treating osteoporosis focus on inhibiting bone resorption. As the only US FDA-approved anabolic agent, the recombinant human parathyroid hormone is recommended for consecutive 2-year period treatment in a clinical setting. Therefore, it is highly desirable to identify novel bone anabolic agents or approaches for osteoporosis treatment. In this review, the authors introduce a new bone anabolic therapy by means of RNAi strategy. Specifically, the authors also discuss the current status and perspectives for RNAi as a novel anabolic approach in the treatment of osteoporosis.Expert Review of Endocrinology & Metabolism 01/2014; 7(6).
- [Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Osteoporosis medications increase bone-mineral density (BMD) and lower but do not eliminate fracture risk. The combining of anabolic agents with bisphosphonates has not improved efficacy. We compared combined teriparatide and denosumab with both agents alone. METHODS: From September, 2009, to January, 2011, we enrolled postmenopausal women with osteoporosis into this randomised, controlled trial. Patients were assigned in a 1:1:1 ratio to receive 20 μg teriparatide daily, 60 mg denosumab every 6 months, or both. BMD was measured at 0, 3, 6, and 12 months. Women who completed at least one study visit after baseline were assessed in a modified intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT00926380. FINDINGS: 94 (94%) of 100 eligible women completed at least one study visit after baseline. At 12 months, posterior-anterior lumbar spine BMD increased more in the combination group (9·1%, [SD 3·9]) than in the teriparatide (6·2% [4·6], p=0·0139) or denosumab (5·5% [3·3], p=0·0005) groups. Femoral-neck BMD also increased more in the combination group (4·2% [3·0]) than in the teriparatide (0·8% [4·1], p=0·0007) and denosumab (2·1% [3·8], p=0·0238) groups, as did total-hip BMD (combination, 4·9% [2·9]; teriparatide, 0·7% [2·7], p<0·0001; denosumab 2·5% [2·6], p=0·0011). INTERPRETATION: Combined teriparatide and denosumab increased BMD more than either agent alone and more than has been reported with approved therapies. Combination treatment might, therefore, be useful to treat patients at high risk of fracture. FUNDING: Amgen, Eli Lilly, National Center for Research Resources.The Lancet 05/2013; · 39.21 Impact Factor