Anabolic plus antiresorptive: Is one plus one more or less two?

Abstract

The anabolic effect of parathyroid hormone (PTH) 1-34 is remodeling- and modeling-based. Prior or concurrent use of remodeling suppressants may blunt the rise in remodeling markers and bone mineral density (BMD) produced by PTH1-34, perhaps because 70% of the anabolic effect of PTH1-34 is remodeling-based. Cosman et al. report the opposite; PTH1-34 plus zoledronic acid (ZA) initially produced a greater increase in BMD than PTH1-34 alone. While this may be the result of the modeling-based anabolic effect of PTH1-34 (which is not suppressed by ZA), it is unlikely to be the only explanation as modeling-based bone formation probably also occurs when blunting is reported with other combined antir..