Sequential osteoporosis treatments.

Area of Science:

• Endocrinology and Metabolic Bone Diseases
• Public Health
• Pharmacology

Background:

• Osteoporosis represents a significant public health challenge due to its high prevalence and association with severe fractures.
• The chronic and progressive nature of osteoporosis, coupled with an aging population, necessitates prolonged treatment strategies, often involving sequential use of different medications.

Purpose of the Study:

• To review the current landscape of osteoporosis treatment sequencing.
• To identify factors influencing the selection of subsequent osteoporosis therapies when a change is indicated.

Main Methods:

• Review of existing literature and clinical recommendations regarding osteoporosis drug sequencing.
• Analysis of factors contributing to the need for switching osteoporosis medications, such as fracture occurrence, adherence, side effects, and completion of first-line therapy.
• Evaluation of the scientific evidence supporting specific drug sequences.

Main Results:

• Current guidelines primarily address first-line osteoporosis treatment, with limited recommendations for sequential therapy.
• Most studies on drug sequences lack robust designs (e.g., open-label) and do not collect fracture data, hindering evidence-based sequencing.
• A specific sequence is supported only for teriparatide followed by a bone resorption inhibitor.

Conclusions:

• The selection of a second-line osteoporosis drug relies heavily on clinical judgment.
• Key factors guiding this decision include insurance coverage, osteoporosis severity, fracture risk profile, patient comorbidities, drug contraindications, and adherence.