Don't combine human parathyroid hormone and a bisphosphonate
Two studies' results were emailed today as early-release studies by the New England Journal of Medicine that showed that the combination of Forteo (injected human parathyroid hormone), and Alendronate (Fosamax) were not synergistic. In fact, adding Fosamax along with Forteo impaired the the latter medication's ability to increase bone mineral density (BMD). Interestingly, the results were published for both a study on postmenopausal women by Black, DM and others and on men by Finkelstein JS and others. So, if your physician had considered keeping you on a bisphosphonate while starting Forteo, that thought should now be dropped. It is still no problem to continue the bisphosphonate once you discontinue using the Forteo in order to maintain the gain in BMD. I suggest reading the full PDF version of the articles by clicking that link on the Web page, and particularly to look at the graphs that show the results of all the medication combinations used. You will see that Forteo plus Fosamax was definitely better than Fosamax alone, but that it was worse than Forteo alone. But the most interesting result is the huge difference in percentage of increase in BMD when comparing Fosamax and Forteo. But, also keep in mind that the dose of Forteo was almost double the final FDA-approved dose of 20 micrograms thus accounting for some of the dramatic results. This will reemphasize the importance of considering the use of Forteo for a year or two to quickly and significantly increase BMD and reduce fracture risk for those men who have severe osteoporosis.