Which Drug Next? Sequential Therapy for Osteoporosis.

The proliferation of drugs with unique modes of action for treating osteoporosis has been most welcome. Fear of complications , even though rare, associated with long term bisphosphonates, changed prescribing patterns. The Bisphosphonates are stored in bone for years. Drugs not stored in bone; e.g. abaloparatide, teriparatide, denosumab, and romosozumab have expanded our armamentarium for treating osteoporosis but have brought new challenges. Bone accrued during treatment with the latter 3 drugs, and perhaps abaloparatide, is lost rapidly after their withdrawl due to rebound increase in bone resorption. Treatment with these drugs must be followed by administration of an anti-resorptive agent.. The article by Kendler et al. in this issue of JCEM reports alendronate preserves bone accrued during administration of denosumab.

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