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Combination teriparatide and denosumab more effective than either therapy alone


Previous studies have shown that teriparatide and bisphosphonates do not show synergistic effects when used in combination to treat patients with osteoporosis. This small study by Tsai et al. looked at the potential benefit of combining teriparatide with denosumab, a monoclonal antibody that blocks RANK/RANKL-mediated bone resorption by osteoclasts.

The results suggest a clear benefit of this type of combination therapy. Women treated with 20 μg teriparatide daily and 60 mg denosumab twice each year showed significantly increased bone mineral density at the lumbar spine (9.1% combination treatment vs 6.2% teriparatide only and 5.5% denosumab only), at the femoral neck (4.2% combination treatment vs 0.8% teriparatide only and 2.1% denosumab only) and at the total hip (4.9% combination treatment vs 0.7% teriparatide only and 2.5% denosumab only).

Editor’s comment: Evidence that teriparatide combined with denosumab increases areal bone mineral density at both spine and hip more than either drug alone challenges the concept that inhibition of bone resorption prevents the anabolic effects of parathyroid hormone. This study also provides a new, provocative concept for the treatment of osteoporosis in patients with very low bone mass and/or high fracture risk.

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