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Combination and sequential treatment in women with postmenopausal osteoporosis

机译：绝经后骨质疏松症的妇女组合和顺序治疗

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Introduction: Since postmenopausal osteoporosis is a chronic, potentially disabling condition requiring long-term treatment, the physician is expected to decide the optimal treatment strategy, e.g. how to use the available osteoanabolic and antiresorptive agents, sequentially or in combination, in the most effective and safe way, based on personalized patient care. Areas covered: Herein, the authors outline clinical data regarding the efficacy and safety of various sequential treatment strategies. More specifically, they compare the efficacy of osteoanabolic agents when they precede or follow antiresorptive treatment, as well as the efficacy of antiresorptives following other antiresorptives. Finally, the authors quote and discuss available evidence regarding the efficacy and safety of the co-administration of osteoanabolics and antiresorptives in comparison with monotherapies. Expert opinion: Initiation with an osteoanabolic agent followed by an antiresorptive seems to be the optimal treatment sequence, at least in patients with severe osteoporosis. Osteoanabolic treatment following antiresorptives seems to lead in more modest responses in bone mineral density (BMD) and bone turnover markers. Combination therapy with teriparatide and denosumab or zoledronate has achieved higher BMD gains compared to each agent alone; however, due to the high cost, combination therapy is rarely compensated. On the contrary, the combination of teriparatide with alendronate results in smaller BMD increases than TPTD monotherapy.
机译：介绍：由于绝经后骨质疏松症是一种慢性，可能禁用需要长期治疗的条件，预计医生将决定最佳治疗策略，例如，如何以个性化患者护理的方式顺序或组合使用可用的骨代谢和反侧代理，或者组合使用。所涵盖的区域：在此，作者概述了关于各种连续治疗策略的疗效和安全性的临床资料。更具体地，它们比较骨代谢试剂在前面或遵循反侧处理时的疗效，以及反射性遵循其他反射性的效果。最后，作者报价并讨论了关于骨蛋白酶和反射性的协同施用的有效性和安全性的可用证据与单疗法相比。专家意见：用骨代谢代理的启动，随后是反射性似乎是最佳治疗序列，至少在严重骨质疏松症的患者中。骨果酸酯治疗似乎在骨矿物密度（BMD）和骨质周转标记中呈现更适度的反应。与单独的每种试剂相比，用萜壶肽和Denosumab或唑仑的组合治疗达到了更高的BMD增益;但是，由于成本高，组合疗法很少得到补偿。相反，Triparidide与阿仑膦酸盐的组合导致较小的BMD增加而不是TPTD单药治疗。

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