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Controversies in Osteoporosis Management: Antiresorptive Therapy for Preventing Bone Loss When to Use One or Two Antiresorptive Agents?


Clinical Obstetrics and Gynecology: December 2013 - Volume 56 - Issue 4 - p 749–756
doi: 10.1097/GRF.0b013e3182a982c2
Controversies in Osteoporosis Management

Women who have significant bone loss or a new fracture on monotherapy are considered for combination therapy. Combination therapies increase bone density more than monotherapy by targeting different parts of the osteoclast pathway.

In early postmenopausal women who are symptomatic, the use of combination antiresorptives should include hormone therapy with a bisphosphonate or with bazodoxifene. In women who initially receive a weaker antiresorptive such as the SERM raloxifene, a combination with bisphosphonates and calcium supplementation is necessary to prevent bone loss. In older women over 65 years of age who often have impaired calcium absorption, the combination of calcitriol with bisphosphonates has been shown to increase bone density more than monotherapy.

Departments of *Endocrinology;

Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska

The authors declare that they have nothing to disclose.

Correspondence: J. Christopher Gallagher, MD, Department of Endocrinology, Creighton University School of Medicine, Suite 6718, Omaha, NE. E-mail:

© 2013 by Lippincott Williams & Wilkins.