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COMBINATION THERAPY
Combination therapy (especially
combining bisphosphonates and estrogen) seem promising for future in the treatment
of osteoporosis in postmenopausal women. A recent study 13
evaluated the addition of alendronate to ongoing hormone replacement
therapy (HRT) in the treatment of postmenopausal women with osteoporosis. A
total of 428 postmenopausal women with osteoporosis, who had been receiving
HRT for at least 1 year, were randomized to receive either alendronate (10 mg/day)
or placebo. HRT was continued in both groups. Changes in bone mineral density
(BMD) and biochemical markers of bone turnover were assessed. The results demonstrated
that compared with HRT alone, at 12 months, alendronate plus HRT produced significantly
greater increases in BMD of the lumbar spine (3.6% vs. 1.0%, P < 0.001) and
hip trochanter (2.7% vs. 0.5%, P < 0.001. Addition of alendronate to ongoing
HRT was generally well tolerated, with no significant between-group differences
in upper gastrointestinal adverse events or fractures. 
Another prospective, double blind, placebo-controlled, randomized clinical trial examined the effects of oral alendronate and conjugated estrogen, in combination and separately, on BMD, biochemical markers of bone turnover, safety, and tolerability in 425 hysterectomized postmenopausal women with low bone mass. The results demonstrated that combined use of alendronate and estrogen produced somewhat larger increases in BMD than either agent alone and was well tolerated.14 Whether combination therapy leads to a reduction of fractures remains to be established.
Canada has just recently approved (April 2001) the combination of alendronate and HRT for the treatment of postmenopausal osteoporosis.
At this juncture, there are no published trials utilizing calcitonin and alendronate, therefore this combination is not recommended because of lack of data and increased cost. Combinations of calcitonin and estrogen have shown some beneficial additive effects on BMD.
Combinations of parathyroid hormone and ERT are currently being evaluated as well, and show great promise for management of osteoporosis in postmenopausal women. 1
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