The use of combination therapy in treatment of postmenopausal osteoporosis

Bone Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
Endocrine (Impact Factor: 3.88). 02/2012; 41(1):11-8. DOI: 10.1007/s12020-011-9554-2
Source: PubMed


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.

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    • "A range of pharmacological interventions are available for the treatment of postmenopausal osteoporosis, including antiresorptive as well as anabolic agents.1 While mono-therapy is the most common treatment approach for the majority of patients, combined or sequential therapy with antiresorptive and anabolic agents may also be used in some cases.1,2 This treatment modality has attracted increased interest in recent years because of the potential synergistic effect on bone strength,3,4 as well as the fact that particularly with potent antiresorptive agents, it may be desirable to limit the duration of therapy for a finite period of time, for example five years5 and that some other form of treatment may be required in individuals who remain at high risk for fractures after this period. "
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    ABSTRACT: OBJECTIVE 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. SUBJECTS AND METHODS A sample of 13 postmenopausal women with osteoporosis was analyzed (mean age 65 ± 7.7 years), who were treated with SR for an average of 2.56 ± 0.86 years. All patients had undergone previous treatment with bisphosphonates for an average period of 4.88 ± 2.27 years. Serum CTX and osteocalcin levels were determined before and after four months of treatment with SR. Bone mineral density in the lumbar spine and femoral neck were obtained before and after treatment with SR. RESULTS We observed an average increase of 53.7% in the CTX levels, and 30.7% in the osteocalcin levels. The increase in bone markers was associated with a mean 4.8% increase in lumbar spine bone mineral density (BMD) from 0.820 to 0.860 g/cm2 (T-score from −2.67 to −1.92; P = 0.001), after 2.5 years of treatment with SR. CONCLUSION These data suggest an anabolic effect of SR on postmenopausal women who were previously treated with long-term bisphosphonates.
    05/2014; 7:7-11. DOI:10.4137/CMED.S15086
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    • "The clinical trials in postmenopausal women show that strontium ranelate reduces the risk of fractures and was well tolerated apart from a low rate of gastrointestinal sideeffects and an increased risk of venous thrombosis [14]. Estrogen, bisphosphonates, calcitonin, calcium products, ipriflavone, and anabolic steroids are clinically used as effective medications [15]; however, each of them has established some side effects. Many medicinal plants have long been used to prevent and treat osteoporosis in many countries. "
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    ABSTRACT: Osteoporosis is a major health hazard and is a disease of old age; it is a silent epidemic affecting more than 200 million people worldwide in recent years. Based on a large number of chemical and pharmacological research many plants and their compounds have been shown to possess antiosteoporosis activity. This paper reviews the medicinal plants displaying antiosteoporosis properties including their origin, active constituents, and pharmacological data. The plants reported here are the ones which are commonly used in traditional medical systems and have demonstrated clinical effectiveness against osteoporosis. Although many plants have the potential to prevent and treat osteoporosis, so far, only a fraction of these plants have been thoroughly investigated for their physiological and pharmacological properties including their mechanism of action. An attempt should be made to highlight plant species with possible antiosteoporosis properties and they should be investigated further to help with future drug development for treating this disease.
    Evidence-based Complementary and Alternative Medicine 12/2012; 2012(8):364604. DOI:10.1155/2012/364604 · 1.88 Impact Factor
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    ABSTRACT: To summarize promising areas of investigation in osteoporosis and to stimulate further research in this area, as discussed in a recent international conference. Over the recent years, there has been an improvement in the knowledge of molecular pathways involved in bone formation and resorption with the development of new drugs to treat osteoporosis. Intact parathyroid hormone, teriparatide, and anti-sclerostin monoclonal antibody are anabolic drugs, whereas denosumab and odanacatib are anti-resorptive drugs with more reversible effects as compared to bisphosphonates. Anabolic and anti-resorptive agents have different effects on bone, and research in this area includes the efficacy of combination and sequential therapies with them. New insights in the molecular pathways of bone remodeling have clarified the mechanisms responsible for skeletal fragility in several forms of secondary osteoporosis, such as that occurring in type 2 diabetes, following drug exposure and systemic inflammatory diseases. Future research is needed to address the efficacy of anti-osteoporotic drugs in these more recently recognized conditions of skeletal fragility. Osteoporosis continues to be an important field of biomedical research.
    Endocrine 12/2011; 41(1):58-69. DOI:10.1007/s12020-011-9570-2 · 3.88 Impact Factor
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