Most women today who are receiving pharmacotherapy for treatment of osteoporosis receive oral bisphosphonates (e.g., alendronate, risedronate). Other effective treatments, like teriparatide (TERI) and denosumab (DENO) are usually reserved for more severe cases, in some part because they require parenteral administration.
Even though osteoporosis treatments have shown risk reduction for fracture and improved bone mineral density (BMD), restoration of full bone integrity remains a challenge. As one of the few anabolic tools (as opposed to anticatabolic tools like bisphosphonates), some investigators have tried to augment the favorable activity of TERI by combination with bisphosphonates, but the results have been disappointing. Whether the addition of DENO to TERI might be beneficial was the subject of investigation by Tsai et al. Postmenopausal women with osteoporosis (n = 100) were randomized to DENO, TERI, or both for 6 months. The primary outcome of the study was improvement in BMD.
Combination TERI+DENO appeared to be synergistic, with improvements in BMD greater than either agent alone and arithmetically greater than the anticipated benefit of combined monotherapies. For example, BMD increases at the hip were 4.2% for TERI+DENO, 0.8% for TERI, and 2.1% for DENO. These data support the consideration of TERI+DENO in highest-risk patients, those unable to take other treatments, or patients who fail to respond to other regimens.
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