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Combination therapy is generally reserved for  experienced a fracture while on therapy with a single drug, those who start out with a very low BMD and a history of multiple fractures, those with very low BMD who lose more bone mass on therapy with a single drug.

Combinations of bisphosphonates and HT or raloxifene have been shown to increase BMD greater than either agent alone.

At this time, it has not been determined if these combinations reduce fracture risk greater than single agent therapy.

Combination Therapies-Combination Antiresorptive/Anabolic Therapy. Alendronate/PTH combination would have a synergistic or at least additive effect on BMD. Increases in BMD in cortical bone with short-term combination therapy were less than with PTH alone

Combination Therapies-Sequential Therapy

Sequential treatment with PTH for a year followed by alendronate for a year showed that sequential treatment resulted in substantial increases in vertebral BMD. (Rittmaster et al. Enhancement of bone mass in osteoporotic women with parathyroid hormone followed by alendronate. J Clin Endocrinol Metab. 2000;85:2129-2134.)

Combination Therapy Medications for Osteoporosis