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