Treatment of osteoporosis: combination therapies

Several classes of medication are available for the prevention and/or treatment of osteoporosis including reproductive hormones, bisphosphonates, selective estrogen-receptor modulators, calcitonin and most recently parathyroid hormone. These medications, acting through different mechanisms, have been shown to preserve or increase bone mineral density and some ultimately reduce osteoporotic fracture. The benefits of these individual therapeutic approaches appear limited leading some investigators to use the agents in combination in an effort to achieve additional effects. Few studies looking at the effects of combination therapies are currently available for review. While the results of the available studies are generally positive, they lack the statistical power to satisfactorily demonstrate any additional contribution to fracture reduction. The potential synergistic effects of combination therapies are just beginning to be explored. Until more information is available, recommendations for use of combination therapies should be limited to specific clinical situations.