Combination of anabolic and antiresorptive agents for the treatment of osteoporosis

Combination therapy strategies for osteoporosis are reviewed in this article. Regimens including two antiresorptives agents increase BMD more than single therapy alone, but they have not proved to reduce fracture risk. The alternative of combining antiresorptives together with anabolics has gained more interest. There are, however, many questions still pending, as which antiresorptive should be used, and the appropriate sequence of the treatments. It seems that bisphosphonates can blunt the anabolic effect of parathyroid hormone (PTH) when given simultaneously. Instead, when PTH follows the antiresorptive treatment the anabolic effect seems not to be blunted. Finally, other possible approach would be to initiate therapy with an anabolic agent and maintain the effect with any antiresorptive if necessary.