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Osteoporosis

Mixing Multple Medications

05/21/2002

Question:

My doctor put me on Miacalcin five years ago for osteoporosis. After a bone scan showed no improvement two year later, he added Evista. Now two years later (still no improvement), he has added Fosamax. Is it okay to be on all three at once? Does each do something different or do they cancel each other out?

Answer:

Most experts do not recommend using all three medications together. If your bone density test remained stable on one drug, that is usually sufficient to reduce fracture. Some experts raise the concern that treating with more than one drug could overly suppress the bone remodeling system and prevent the important repair of bone damage. Several other points are also important: Adequate amounts of calcium and vitamin D are required for the medications to be effective. If you are getting the recommended amounts of calcium and vitamin D, taking the medication correctly and your bone density has continued to worsen significantly, it would be advisable to look for other causes of osteoporosis. It is good you waited 2 years between bone density tests for more accurate results. Bone density of the spine and hip are the best way to monitor response to treatment. It is preferrable to use the same machine each time. There is a growing consensus that the amount of increase in bone density on different treatments does not necessarily correlate with the amount of fracture reduction. All of the medications available for the treatment of osteoporosis have demonstrated fracture reduction. There is no evidence that using more than one treatment reduces the fracture rate any further.

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Response by:

Margery   Gass, MD Margery Gass, MD
Formely, Professor, Clinical Obstetrics & Gynecology
College of Medicine
University of Cincinnati