Approach to the Patient - Transitions in Osteoporosis Therapy
Bente L Langdahl1,2, Natasha A Laursen1,2, Vivi Mäkinen1,2
1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.
The Journal of Clinical Endocrinology and Metabolism
|November 17, 2025
Summary
Transitioning osteoporosis treatments requires careful planning. While most drug switches are safe, avoid moving from antiresorptives to bone anabolics or stopping denosumab without follow-up to maintain treatment effectiveness.
Area of Science:
- Endocrinology
- Bone Metabolism
- Pharmacology
Background:
- Osteoporosis management requires sequential treatment strategies.
- Effective osteoporosis therapy involves optimizing treatment transitions.
- Goal-directed therapy necessitates understanding treatment sequence benefits and risks.
Purpose of the Study:
- To evaluate the opportunities and challenges of osteoporosis therapy transitions.
- To identify safe and effective sequential treatment strategies for osteoporosis.
- To inform clinical decision-making regarding osteoporosis drug sequencing.
Main Methods:
- Review of existing literature on osteoporosis treatment transitions.
- Analysis of bone mineral density (BMD) and anti-fracture efficacy data.
- Assessment of safety profiles for various treatment sequences.
Main Results:
- Transitioning from bone anabolics to antiresorptives maintains BMD gains and anti-fracture effects.
- Switching between antiresorptives, especially to parenteral agents like zoledronate or denosumab, can further increase BMD.
- Transitioning from antiresorptives to bone anabolics may blunt anabolic effects.
- Discontinuation of denosumab after 2-3 years poses challenges.
Conclusions:
- Sequential osteoporosis treatment is crucial for fracture prevention and achieving optimal BMD.
- Most osteoporosis treatment transitions are safe and beneficial.
- Avoid transitioning from denosumab to bone anabolics or discontinuing denosumab without subsequent therapy due to potential blunted effects and risks.
Related Concept Videos
01:29Bone Disorders
5.0K
Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
5.0K
01:40Bone Remodeling
40.2K
Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
40.2K
01:31Osteoclasts in Bone Remodeling
3.9K
Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during...
3.9K
01:15Drug Dosing: Geriatric Patients
215
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
215
01:26Drug Administration and Therapy Phases: Overview
1.2K
Drugs, the chemical agents used in diagnosing, treating, or preventing diseases, undergo a four-phase process of development: pharmaceutic, pharmacokinetics, pharmacodynamics, and therapeutic.
The pharmaceutical phase focuses on leveraging the physicochemical properties of the drug to design and manufacture an effective product. Variants include orally administered tablets or capsules, topical creams or ointments, and parenteral-delivery solutions or emulsions.
The pharmacokinetic phase...
The pharmaceutical phase focuses on leveraging the physicochemical properties of the drug to design and manufacture an effective product. Variants include orally administered tablets or capsules, topical creams or ointments, and parenteral-delivery solutions or emulsions.
The pharmacokinetic phase...
1.2K
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
180
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
180