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Combination therapy is effective for
older women with osteoporosis, says Pittsburgh study
EurekAlert,
May 22, 2003
PITTSBURGH – Elderly women with osteoporosis can
significantly and safely improve their bone mass with a combination
therapy of hormone replacement and the bisphosphonate alendronate (Foxamax).
The findings are published in the May 21 issue of the Journal of the
American Medical Association by University of Pittsburgh researchers. "Our study
found that a combination therapy of hormone replacement and alendronate
was well tolerated by elderly women with low bone mass. After three years
of treatment, these women showed significantly greater increases in bone
mass than we saw in similar women taking only one of the therapies,"
said lead author Susan Greenspan, M.D., professor of medicine at the
University of Pittsburgh School of Medicine and director of the
Osteoporosis Prevention and Treatment Center at the University of
Pittsburgh Medical Center. "Combination therapy is a safe, viable
option for postmenopausal women who have been unable to improve their bone
density with an individual therapy, or in women with osteoporosis severe
enough to require a greater increase in bone density." Earlier research has
suggested similar results with younger women, but up to now little data
were available on the effectiveness and safety of combination therapy in
older, post-menopausal women. The study was
conducted with 373 women aged 65 to 90 years. At baseline, participants as
a group had bone mass thin enough to be classified as osteopenia, a
precursor of osteoporosis. Thirty-four percent of the women had
osteoporosis. Participants were
evenly randomized to receive hormone replacement therapy (HRT) (conjugated
estrogen with or without medozyprogesterone) plus alendronate, HRT alone,
alendronate alone, or placebo. All received calcium and vitamin D
supplements. After three years,
dual-energy X-ray absorptiometry (DXA) scans showed that participants
taking combination therapy had greater improvements in bone mineral
density (BMD) at the hip and spine than did those participants taking HRT
or alendronate alone, or placebo. For instance, the
mean increase in BMD at the hip was 5.9 percent with combination therapy,
4.2 percent with alendronate, 3.0 percent with HRT and 0.0 percent with
placebo. At the lumbar spine the mean increases in BMD were 10.4 percent
with combination therapy, 7.7 percent with alendronate, 7.1 percent with
HRT and 1.1 with placebo. Also, in comparing
HRT with alendronate, researchers found that participants taking
alendronate alone had greater improvements in BMD at the hip. While the study was
not designed to examine fractures as an outcome, a higher bone density is
usually associated with fewer fractures. "We applied a
logistic model to our data and determined that combination therapy would
provide an additional 10 percent reduction in fracture over HRT alone and
an additional 8 percent over alendronate alone," said Dr. Greenspan.
"These results can help elderly women decide whether the potential
risk inherent in HRT use is worth taking to reduce the risk of
fracture." Copyright
© 2002 Global Action on Aging
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