No studies have had sufficient powe...

No studies have had sufficient power to point out to that combination antiresorptive therapy--bisphosphonate and estrogen replacement--reduces fracture risk and increases bone mass. Greenspan and colleagues designed a close attention to determine the effect of combination therapy in a assemblage of elderly, community-dwelling women.

Patients in this randomized, double-blind subject of attention took alendronate, hormone therapy (estrogen alone or with progesterone depending onward whether the patient had an intact uterus), the pair drugs, or neither drug. A run-in phase was complet from 373 women, aged 65 to 90 years. issues included bone mineral density (BMD) measurements of the hip, lumbar spine, and radius at baseline, randomization, and six-month intervals for three years. Weight, height, corpse mass index, and activity and mental status parameters were secondary outcomes

All arranges were similar at baseline. After three years, hip BMD increased 59 percent in the combination therapy dispose 4.3 percent in the alendronate collection and 3 percent in the hormone assign places to while patients in the placebo arrange maintained their BMD. Similar trendings were found when measuring density at the femoral neck and greater trochanter. All treatment collections had increased BMD in the posteroanterior lumbar spine and the lumbar spine; women in the combination therapy cluster had the greatest increase in vertebral BMD and the greatest rate of change from baseline. Although the results of combination therapy were superior to the drifts of each agent when taken alone, the benefits were not additive. There was considerable variation in reply rate among the active-treatment assemblages with older participants generally responding les frequently than younger patients.

Combination therapy with alendronate and hormone therapy improved BMD in community-dwelling somewhat old women better than therapy with either agent alone. Although direct measurement of impact forward fractures was not part of this thought the authors estimate that combination therapy would model fractures by an additional 10 percent compared with hormone therapy alone and by the agency of an additional 8 percent compared with alendronate alone. The risks of including estrogen replacement in the therapeutic regimen must be weighed against the benefits of potential fracture reduction, especially in women who do not answer to monotherapy.

Greenspan SL et al. Combination therapy with hormone replacement and alendronate for prevention of bone los in somewhat old women. A randomized controlled trial. JAMA May 21 2003;289:2525-33

COPYRIGHT 2004 American Academy of Family Physicians

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