Combination therapy of anabolic agents and bisphosphonates on bone mineral density in patients with osteoporosis: a meta-analysis of randomised controlled trials

Osteoporosis is characterized by low bone mass and deterioration of the bone tissue. Despite various drugs, there is no evidence that single use of any agent can restore skeletal integrity. Therefore, in the present study, the author showed the concomitant combination therapy of anabolic agents and bisphosphonates significantly improved the bone mineral density (BMD) at the total hip and femoral neck injury.

The study intended to compare the effects of the concomitant combination therapy of anabolic agents and bisphosphonates and anabolic agents alone on bone mineral density (BMD) of osteoporosis patients.  

EMBASE, the Cochrane Library, and MEDLINE from 1 January 1980 to 1 August 2016 were searched to evaluate all the randomised controlled trials (RCTs) and quasi-RCTs. The total hip and the femoral neck with an optimal period of therapy and the average per cent changes in BMD at the lumbar spine were considered as the primary outcomes and the average per cent changes in BMD at the same sites with the full period of recommendation (18 to 24 months) was considered as the secondary outcome. The estimation of the standardised mean differences (SMDs) and the 95% Cis was done by using a random-effects model.

A total of seven studies comprising 747 patients were selected. The concomitant combination treatment with the optimal period exhibited a remarkable benefit over monotherapy in BMD improvement at the total hip and the femoral neck. However, the concomitant combination treatment with the full period showed no improvement in BMD at the lumbar spine, the total hip and the femoral neck.

The combination treatment exhibited significant improvement in BMD at the total hip and femoral neck with a shorter term and presented the same advantages on BMD for the longer time as compared to the anabolic monotherapy. Moreover, the efficacy of concomitant combination treatment might be influenced by the dose of anabolic agents.