Sequential therapy in the treatment of osteoporosis

Objective: To review the clinical data in the sequential use of antiresorptive and anabolic agents for the treatment of osteoporosis. Methods: The US National Library of Medicine was used to obtain the relevant information on osteoporosis management involving antiresorptive and anabolic bone agents. Results: Antiresorptive and anabolic therapies are the two main types of medications approved for osteoporosis treatment. The efficacy of these agents in fracture risk reduction is well established. Many patients with osteoporosis are first treated with an antiresorptive agent, most commonly a bisphosphonate. Osteoporotic patients who fail to respond to antiresorptive therapy or patients with severe osteoporosis may require anabolic therapy at some point during their disease. Recombinant human parathyroid hormone (PTH) is an anabolic agent with proven benefits on bone strength. Sequential therapy using PTH after antiresorptive agents has been found beneficial for bone health. Recent research suggests that the speed and magnitude of PTH effect can differ, depending on the previous antiresorptive therapy. Upon PTH cessation, subsequent antiresorptive therapy may help maintain or increase gains in bone mass. Conclusions: Although further research is needed to determine the long-term significance of prior antiresorptive therapies and their differing effects on fracture risk reduction with subsequent PTH therapy, patients with severe osteoporosis should be considered for this treatment option, regardless of prior osteoporosis treatment.