Combination therapies in the treatment of osteoporosis.

PURPOSE OF REVIEW: Osteoporotic fractures are common and can be devastating. Although multiple different medications with unique mechanisms of action are currently available in our arsenal to attempt to prevent fractures, an ideal opportunity in which to use these medications in combination remains elusive. New data has emerged over the past few years in regards to assessing which medication combinations may be productive and efficacious.

RECENT FINDINGS: Previous studies performed using different medications to treat osteoporosis in combination proved either not overall beneficial or inconclusive. More recent studies suggest a potential additive and synergistic benefit of certain combination therapies, particularly with the use of denosumab and teriparatide in select situations.

SUMMARY: The knowledge of modern data as to when the potential use of combination therapy in treating osteoporosis may be useful is critical to the acquisition of proficiency in the ideal management of our patients at highest risk for fracture. Although not recommended yet by current guidelines, the advancement of expertise in this field, both in research studies, and clinical practice, will help us discern how to best consider the use of combination treatment now and in the future.