Combination Therapy for Postmenopausal Osteoporosis
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There is insufficient evidence to recommend combination therapy for the routine management of postmenopausal osteoporosis. (Strength of Recommendation [SOR]: C, based on expert opinion). Combination therapy with parathyroid hormone (PTH) and a bisphosphonate is less effective than treatment with PTH alone, and should not be used. (SOR: C, based on a randomized trial using disease-oriented end points). However, combination therapy with raloxifene (Evista) and a bisphosphonate or PTH, and sequential treatment with PTH followed by alendronate (Fosamax) have been shown to increase bone mineral density (BMD) more than single-agent therapy and may be considered in patients with severe or refractory postmenopausal osteoporosis. (SOR: C, based on expert opinion).
American Family Physician, 81(4) 2010: 439-440.