Combining Bisphosphonates with Raloxifene to Treat Osteoporosis: A Review of the Evidence

Abstract

Objective:

To evaluate published studies regarding the combination of a bisphosphonate and raloxifene in the treatment of osteoporosis.

Data Sources:

A MEDLINE search (1966–February 2006) was conducted using the search terms osteoporosis, alendronate, risedronate, ibandronate, raloxifene, bisphosphonate, treatment, and selective estrogen-receptor modulators.

Study Selection and Data Extraction:

Clinical trials examining the efficacy of bisphosphonate and raloxifene in the treatment of osteoporosis were reviewed. Two trials evaluated alendronate or clodronate plus raloxifene for the treatment of osteoporosis in postmenopausal women.

Data Synthesis:

The results demonstrated a significant increase in lumbar bone mineral density (BMD) and conflicting results in the femoral BMD. Fracture risk was not assessed in either study.

Conclusions:

Published trials assessed BMD rather than fracture risk and were limited by methodologic flaws. Due to insufficient clinical outcomes data, combining these antiresorptive treatments cannot be recommended.