Endocrine Abstracts

Postmenopausal osteoporosis is a chronic condition requiring long-term treatment. Based on personalized patient care the physician should decide the optimal treatment strategy, namely the use of the available osteoanabolic and antiresorptive agents, sequentially or even in combination, in the most effective and safe way. Transitioning from one antiresorptive to another is probably the most common treatment sequence in clinical practice. In this context transition to a potent oral or intravenous bisphosphonate is mandatory to maintain bone mineral density (BMD) gains and avoid the rebound phenomenon and the increase in fracture risk in patients discontinuing Denosumab. Initiation with an osteoanabolic agent followed by an antiresorptive seems to be the optimal treatment sequence, at least in patients with severe osteoporosis and prevalent fractures. Treatment with an osteoanabolic following an antiresorptive agent seems to lead in more modest responses in BMD and bone turnover markers. Although switching to teriparatide is a quite common strategy among patients that either did not adequately respond to antiresorptives or have completed the maximum duration of antiresorptive treatment, this could lead to a transient loss of hip BMD and probably strength, and therefore it should be carefully followed especially in high-risk patients. Combination of teriparatide with denosumab or zoledronate has achieved higher BMD gains compared to each agent alone. On the contrary, the combination of teriparatide with alendronate results in smaller BMD increases than teriparatide monotherapy. However, due to the high cost, combination therapy is rarely reimbursed. In conclusion, it is a real challenge for the physician to set the optimal long- term osteoporosis treatment plan for each individual patient based on different needs, preferences, and peculiarities.