Osteoporosis, bone & mineral

A systematic review and meta-analysis of sequential treatment strategies for osteoporosis

Osteoporos IntPublished Systematic review and meta-analysis

An erratum to this article was published (Osteoporos Int, Jan 2026 ↗)

Authors' conclusion

These findings provide a rigorous summary of the evidence to guide sequential medication choice for patients with osteoporosis.

Study context

Population
Patients with osteoporosis receiving sequential osteoporosis medication; primary studies from PubMed, Embase and Cochrane Library39 primary studies
Comparison
Sequential osteoporosis treatment strategies
Outcome
BMD change on the second medication in a treatment sequence (lumbar spine, femoral neck, total hip)
Follow-up
1 year
Methodological detailspre-specified inclusion criteria
  • Pre-specified inclusion criteria

Pooled result

As reported in the abstract

BMD change on second medication, summary estimate
Bisphosphonates → romosozumab, lumbar spine
10.1% (95% CI 9.9-10.4)
Bisphosphonates → romosozumab, femoral neck
3.1% (95% CI 2.9-3.4)
Bisphosphonates → romosozumab, total hip
3.1% (95% CI 2.7-3.5)
Romosozumab → denosumab, lumbar spine
4.0% (95% CI 1.2-6.7)
Romosozumab → denosumab, femoral neck
2.2% (95% CI 0.5-3.8)
Romosozumab → denosumab, total hip
2.8% (95% CI 0.8-4.9)
Bisphosphonates → denosumab, lumbar spine
3.5% (95% CI 2.8-4.2)
Bisphosphonates → denosumab, femoral neck
1.5% (95% CI 1.2-1.9)
Bisphosphonates → denosumab, total hip
2.1% (95% CI 1.8-2.3)
Bisphosphonates → teriparatide, lumbar spine
5.1% (95% CI 4.4-5.9)

Original publication

A systematic review and meta-analysis of sequential treatment strategies for osteoporosis. Osteoporos Int. Published 17 October 2025. doi:10.1007/s00198-025-07717-5

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