HRT/bisphosphonate combo no better than either alone for osteoporosis

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Rheumawire

Feb 23, 2004

HRT/bisphosphonate combo no better than either alone for osteoporosis

Helsinki, Finland - Combining hormone replacement therapy (HRT) and

alendronate (Fosamax®, Merck) does not increase bone mass more than

either treatment alone, according to a study of postmenopausal women

with osteoporosis [1]. The findings appear in the February 2004 issue of

the Journal of Clinical Endocrinology & Metabolism.

Most previous studies have favored the combination of HRT and

biphosphonate over at least HRT alone, but " in terms of

bone-mineral-density [bMD] changes, the single treatments were equally

effective, but the reductions in bone markers were less with HRT than

with alendronate, " conclude researchers, led by Dr Sirpa Evio (Helsinki

University Central Hospital, Helsinki, Finland).

Evio et al compared alendronate, HRT, and their combination for the

treatment of osteoporosis among elderly postmenopausal women.

The randomized trial included 90 women aged 65 to 80, with a mean age of

71. Participants had a T-score for BMD of 2.5 or less at either the

lumbar spine or the femoral neck. They received 10-mg alendronate, 2-mg

estradiol plus 1-mg norethisterone acetate, or both regimens for 2

years.

Lumbar-spine and upper-femur BMD was measured at baseline and at 1 and 2

years. Researchers assayed urinary excretion of type I collagen

aminoterminal telopeptide (as related to creatinine) and serum type I

procollagen aminoterminal propeptide at baseline and at 6-month

intervals throughout the 2-year study.

Overall, the increases of 9.1% to 11.2% in lumbar-spine BMD at 2 years

were similar in all study groups, but only HRT increased femoral-neck

BMD at both 1 and 2 years. In addition, total hip BMD increased

similarly in all study groups. Percentage reductions in urinary type I

collagen aminoterminal telopeptide in the HRT group were significantly

smaller than those in the combination group and the alendronate-only

group. Serum type I procollagen aminoterminal propeptide also decreased

less in the HRT group than in the other groups.

Dr Errol H Rushovich (Mercy Hospital, Baltimore, MD) says " the new

information will lead us to examine our use of these drugs in

combination, and we would be less likely to use them in combination in

osteoporosis and may examine patients who are currently on the

combination. "

He adds that the new study " supports the fact that if we drop 1 of the

drugs, it would not make a difference, but there may still be a role for

the combination in patients who have not responded to either. "

Mann

Source

1. Evio S, Tiitinen A, Laitinen K, Ylikorkala O, Valimaki MJ. Effects of

alendronate and hormone replacement therapy, alone and in combination,

on bone mass and markers of bone turnover in elderly women with

osteoporosis. J Clin Endocrinol Metab 2004 Feb; 89(2):626-31.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org