Combination or sequential therapy may benefit the approximately 15% of osteoporosis patients who continue to lose bone on monotherapy.
Greater bone-density increases result from bisphosphonate plus either estrogen or raloxifene than from single-agent therapy.
The introduction of parathyroid hormone (PTH) (1-34), a therapy that stimulates bone formation, will likely result in development of combination or sequential regimens of PTH plus an antiresorptive agent.
Estrogen may be indicated early in the transition to menopause, but many authorities recommend switching to a bisphosphonate in late postmenopause.
For menopausal women with a recent osteoporotic fracture, 1 month of calcitonin treatment may help increase bone density and reduce fracture pain. After the pain has resolved, a bisphosphonate, raloxifene, or PTH can be started.