Sequential therapy in the treatment of osteoporosis

Abstract

Objective:

To review the clinical data in the sequential use of antiresorptive and anabolic agents for the treatment of osteoporosis.

Methods:

The US National Library of Medicine was used to obtain the relevant information on osteoporosis management involving antiresorptive and anabolic bone agents.

Results:

Antiresorptive and anabolic therapies are the two main types of medications approved for osteoporosis treatment. The efficacy of these agents in fracture risk reduction is well established. Many patients with osteoporosis are first treated with an antiresorptive agent, most commonly a bisphosphonate. Osteoporotic patients who fail to respond to antiresorptive therapy or patients with severe osteoporosis may require anabolic therapy at some point during their disease. Recombinant human parathyroid hormone (PTH) is an anabolic agent with proven benefits on bone strength. Sequential therapy using PTH after antiresorptive agents has been found beneficial for bone health. Recent research suggests that the speed and magnitude of PTH effect can differ, depending on the previous antiresorptive therapy. Upon PTH cessation, subsequent antiresorptive therapy may help maintain or increase gains in bone mass.

Conclusions:

Although further research is needed to determine the long-term significance of prior antiresorptive therapies and their differing effects on fracture risk reduction with subsequent PTH therapy, patients with severe osteoporosis should be considered for this treatment option, regardless of prior osteoporosis treatment.

Key words::

• Alendronate
• Osteoporosis
• Risedronate
• Sequential therapy
• Teriparatide

Transparency

Declaration of funding

The authors received editorial/writing support in the preparation of this manuscript, funded by Warner Chilcott Pharmaceuticals Inc., and sanofi-aventis US. The authors were fully responsible for all content, editorial decisions, and opinions expressed in this manuscript. The authors received no form of compensation related to the development of this manuscript.

Declaration of financial/other relationships

S.B. has disclosed that he received research support from Amgen, Merck, sanofi-aventis, Procter & Gamble Pharmaceuticals, Warner Chilcott, and Servier. K.M., E.G., and D.V. have disclosed that they have no relevant conflicts of interest to declare.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgment

Editorial and writing assistance was provided by Tam Vo and team from Excerpta Medica.