Current Osteoporosis Reports

, Volume 15, Issue 4, pp 343–352 | Cite as

Using Osteoporosis Therapies in Combination

  • Michael R. McClungEmail author
Therapeutics and Medical Management (S Jan de Beur and B Clarke, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Therapeutics and Medical Management


Purpose of review

The objective of this review is to update evidence regarding the use of osteoporosis drugs in sequence or in combination to optimize increases in bone mass and strength.

Recent findings

Simultaneous use of denosumab plus teriparatide produces larger increases in BMD than does monotherapy. The use of bisphosphonates or denosumab after teriparatide results in progressive gains in BMD. When switching from bisphosphonates and especially denosumab to teriparatide, an overlap of 6-12 months may prevent the transient loss of BMD in cortical sites. Phase 3 trials document fracture risk reduction with anabolic therapy for 12-18 months followed by an anti-remodeling drug.


With the exception of adding teriparatide to ongoing denosumab therapy, there is little evidence to support the use of more than one osteoporosis drug at a time. In contrast, sequential therapy regimens of anabolic drugs followed by potent anti-remodeling agents will be the new standard for treating patients at imminent risk of fracture.


Osteoporosis anabolic anti-remodeling combination sequential 


Compliance with Ethical Guidelines

Conflict of Interest

Michael McClung reports receiving payment from Amgen, Merck, and Radius Health as a member of their scientific advisory boards and for speaking at scientific meetings.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Institute of Health and AgeingAustralian Catholic UniversityMelbourneAustralia
  2. 2.Oregon Osteoporosis CenterPortlandUSA

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