7. Combination and Sequential Thera

7. Combination and Sequential Therapy
Interest in combination antiresorptive therapies developed from the hope that using two agents with differing mechanisms for inhibiting bone resorption would result in greater increases in bone mineral density and reductions in fracture rates. Studies have evaluated the combination of bisphosphonates plus estrogen or raloxifene or estrogen plus calcitonin. Combination therapy produced greater increases in bone mineral density than single agents in some trials, but there was no further reduction in fracture risk. Combination therapy is also more expensive, and concern has been raised that significant reductions in bone turnover may promote bone that is more brittle. The AACE does not recommend combination antiresorptive therapy for treating osteoporosis. The combination of a bisphosphonate with anabolic therapy (teriparatide) should not be used because a well-controlled trial showed that women receiving the combination actually had smaller increases in bone mineral density than women receiving teriparatide alone. However, sequential therapy with these agents may be more promising. In one study, women who received alendronate for 1 year directly after receiving parathyroid hormone for 1 year had greater increases in bone mineral density than those receiving combination alendronate plus parathyroid hormone, alendronate monotherapy, or parathyroid hormone for 1 year followed by placebo for 1 year. Additionally, patients who received no therapy after 1 year of parathyroid hormone experienced decreases in bone mineral density. Whether sequential therapy leads to reductions in fracture risk remains to be seen.

Results (Indonesian) 1:

7. kombinasi dan terapi urutInterest in combination antiresorptive therapies developed from the hope that using two agents with differing mechanisms for inhibiting bone resorption would result in greater increases in bone mineral density and reductions in fracture rates. Studies have evaluated the combination of bisphosphonates plus estrogen or raloxifene or estrogen plus calcitonin. Combination therapy produced greater increases in bone mineral density than single agents in some trials, but there was no further reduction in fracture risk. Combination therapy is also more expensive, and concern has been raised that significant reductions in bone turnover may promote bone that is more brittle. The AACE does not recommend combination antiresorptive therapy for treating osteoporosis. The combination of a bisphosphonate with anabolic therapy (teriparatide) should not be used because a well-controlled trial showed that women receiving the combination actually had smaller increases in bone mineral density than women receiving teriparatide alone. However, sequential therapy with these agents may be more promising. In one study, women who received alendronate for 1 year directly after receiving parathyroid hormone for 1 year had greater increases in bone mineral density than those receiving combination alendronate plus parathyroid hormone, alendronate monotherapy, or parathyroid hormone for 1 year followed by placebo for 1 year. Additionally, patients who received no therapy after 1 year of parathyroid hormone experienced decreases in bone mineral density. Whether sequential therapy leads to reductions in fracture risk remains to be seen.

Results (Indonesian) 2:

7. Kombinasi dan Sequential Terapi
Bunga dalam kombinasi terapi antiresorptif dikembangkan dari harapan bahwa menggunakan dua agen dengan berbeda mekanisme untuk menghambat resorpsi tulang akan menghasilkan peningkatan yang lebih besar dalam kepadatan mineral tulang dan penurunan angka patah tulang. Penelitian telah mengevaluasi kombinasi bifosfonat ditambah estrogen atau raloxifene atau estrogen plus kalsitonin. Terapi kombinasi yang dihasilkan meningkat lebih besar dalam kepadatan mineral tulang dari agen tunggal di beberapa uji coba, tapi tidak ada pengurangan lebih lanjut dalam risiko patah tulang. Terapi kombinasi ini juga lebih mahal, dan perhatian telah dibangkitkan bahwa pengurangan yang signifikan dalam turnover tulang dapat mempromosikan tulang yang lebih rapuh. The AACE tidak merekomendasikan terapi antiresorptif kombinasi untuk mengobati osteoporosis. Kombinasi dari bifosfonat dengan terapi anabolik (teriparatid) tidak boleh digunakan karena percobaan yang terkendali dengan baik menunjukkan bahwa perempuan yang menerima kombinasi benar-benar memiliki peningkatan yang lebih kecil dalam kepadatan mineral tulang dibandingkan perempuan yang menerima teriparatid saja. Namun, terapi sekuensial dengan agen ini mungkin lebih menjanjikan. Dalam sebuah penelitian, perempuan yang menerima alendronate selama 1 tahun langsung setelah menerima hormon paratiroid selama 1 tahun mengalami peningkatan yang lebih besar dalam kepadatan mineral tulang dibandingkan mereka yang menerima kombinasi alendronate ditambah hormon paratiroid, monoterapi alendronate, atau hormon paratiroid selama 1 tahun diikuti dengan plasebo selama 1 tahun . Selain itu, pasien yang tidak menerima terapi setelah 1 tahun hormon paratiroid mengalami penurunan kepadatan mineral tulang. Apakah terapi sekuensial mengarah ke pengurangan risiko patah tulang masih harus dilihat.