Sequential Versus Step-Therapy Approaches for Osteoporosis Management in Orthopedic Subspecialties

Area of Science:

• Bone biology and osteoporosis pharmacotherapy.
• Orthopedic outcomes and bone quality.

Background:

• Osteoporosis affects millions, leading to millions of fractures annually, with suboptimal treatment rates.
• Current treatment paradigms often delay anabolic agents, reserving them for later-line use.

Purpose of the Study:

• To review and compare anabolic-first sequential therapy versus traditional step-therapy for osteoporosis.
• To examine the relevance of these paradigms in orthopedic populations.

Main Methods:

• Systematic review of 37 studies meeting PRISMA-ScR inclusion criteria.
• Analysis of bone mineral density, fracture risk reduction, and treatment outcomes.

Main Results:

• Anabolic-first sequential therapy demonstrated superior bone mineral density gains and fracture risk reduction.
• Studies showed significant improvements in lumbar spine bone mineral density and reduced vertebral and hip fracture risks.
• Emerging evidence suggests benefits in orthopedic settings, including hip fracture repair, spinal fusion, and arthroplasty.

Conclusions:

• Anabolic-first sequential therapy is a more effective strategy for high-risk osteoporosis patients.
• This approach offers potential benefits in orthopedic care, supporting earlier anabolic agent consideration.
• Revising treatment policies to facilitate earlier anabolic therapy is recommended for optimal patient outcomes.