Tratamiento anabólico de la osteoporosis. Influencia de los tratamientos antirresortivos

The recent appearance of teriparatide (TRPT) for the anabolic treatment of severe osteoporosis reopens the need to explain some points in relatinship with its use associated with antirresorptive drugs. Osteoporotic women treated with alendronate (ALN) or raloxifene (RLX) maintain their capacity to respond to treatment with TRPT, although those pretreated with RLX have BMD gains similar to those expected in women without previous treatment, while the response of those pre-treated with ALN is more delayed and limited, although not abolished. Combined treatment with ALN and PTH (in women) or TRPT (in men) does not have any synergic effect, although the response on the lumbar BMD is greater than that of ALN alone. On the femoral neck, the combined use of ALN reduces the apparent loss of BMD evaluated by DXA. On the contrary, the combined use of ALN lessens the effect of anabolic treatment on the remodeling markers and volumetric BMD. In men previously treated with TRPT for 18 months, discontinuation of treatment causes loss of lumbar BMD close to 4% in one year, while immediate treatment with ALN induces an additional gain of 5% in the same period. In osteoporotic women treated with PTH for one year, later and immediate treatment with daily ALN causes an important additional gain of BMD that almost doubles that obtained with PTH. One way or the other, absence of data on fractures makes it impossible to clarify definitively the doubts regarding the efficacy of the association of antiresorptive and anabolic treatments.