Common Questions
Is the combination of a bisphosphonate and teriparatide more effective in increasing BMD or decreasing fracture rates than with teriparatide alone?
Combination therapy with teriparatide and a bisphosphonate does not appear, at this time, to offer advantages over the use of teriparatide or an antiresorptive agent alone (1,2). Combining teriparatide with a bisphosphonate does not increase BMD more than with teriparatide or alendronate alone. There are no fracture data that compares the effect of the combination of PTH and alendronate with that of PTH alone.
In individuals who have been treated previously with an antiresorptive agent, the subsequent actions of teriparatide on bone density are delayed transiently if bone turnover is markedly suppressed. However, to maintain the gains in bone density with teriparatide, it is important to follow its use with an antiresorptive agent (3).
- A double blind study randomized 238 women to three treatment groups; 100 ug PTH (1-84) and 10 mg alendronate daily, 100 ug PTH daily, or 10 mg alendronate daily (1). The women (average age 70; 47% with previous fracture) were followed for 12 months. It showed that combined treatment did not result in increased BMD at the lumbar spine compared to either PTH or alendronate alone. It was not powered to detect fracture rate differences. Differences in markers of bone formation did suggest that combined therapy may blunt the anabolic effects of PTH on BMD (1).
- Another study of 83 men with low bone density (followed for 30 months) found that alendronate impaired the ability of teriparatide to increase BMD in the spine and femoral neck (2). The increase in lumbar spine and femoral neck BMD was significantly greater in patients who received teriparatide alone than in those who received either alendronate alone or combination therapy with teriparatide and alendronate.
- Black DM, Greenspan Sl, Ensrud KE, Palermo L,McGowan JA,Lang T, Garnero P, Bouxsein ML, Bilezikian JP, Rosen CJ fpr the PaTH Study Investigators. The effects of parathyroid hormone and alendronate alone or in combination in postmeneopausal osteoporosis. N Engl J Med 2003; 349: 1207-15.
- Finkelstein JS, Hayes A, Hunzelman JL, Hunzelman JL,Wyland JJ, Lee H, Neer RM. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003; 349: 1216-1226.
- Rittmaster RS, Bolognese M, Ettinger MP, Hanley DA, Hodsman AB, Kendler DL, Rosen CJ. Enhancement of bone mass in osteoporotic women with parathyroid hormone followed by alendronate. J Clin Endocrinol Metab 2000; 85: 2129-34.