Evidence map›Paper›PMID 41105226›Full record

SynthesisOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026

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

Smita Nayak, Susan L Greenspan

Erratum issuedAbstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Efficacy of combination and sequential therapy with romosozumab.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

2 authors.

Smita NayakBerkeley Madonna, Inc, Albany, CA, USA. smita.nayak@berkeleymadonna.com.ORCID http://orcid.org/0000-0002-6220-4696
Susan L GreenspanUniversity of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Funding

Long-Term Approaches to Treating OsteoporosisR01AG081466 · NIA · BERKELEY MADONNA, INC. · PI NAYAK, SMITA · 2023 to 2025
$618k
NIA NIH HHS NIH grant P30AG024827NIA NIH HHS NIH grant R01AG081466NIA NIH HHS R01 AG081466
6 · The paper itself

Abstract

We performed a systematic review and meta-analysis of the efficacy of sequential osteoporosis treatment strategies. Sequential strategies resulting in the greatest BMD gain included romosozumab to denosumab or bisphosphonates; teriparatide to romosozumab or denosumab; and bisphosphonates to romosozumab. These findings can help guide sequential medication choice for patients with osteoporosis. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the efficacy of sequential osteoporosis medication strategies on bone mineral density (BMD) and fracture outcomes.

methodsPubmed, Embase, and Cochrane Library databases were searched, and pre-specified criteria were applied to select relevant primary studies for inclusion in this systematic review and meta-analysis.

resultsThirty-nine primary studies were included. Meta-analysis summary estimates for BMD change on the second medication in a treatment sequence showed robust BMD gain with bisphosphonates followed by 1 year of romosozumab at the lumbar spine (10.1%, 95% CI 9.9-10.4), femoral neck (3.1%, 95% CI 2.9-3.4), and total hip (3.1%, 95% CI 2.7-3.5). Moderate BMD gains were found with romosozumab followed by 1 year of denosumab, with summary estimates of 4.0% (95% CI 1.2-6.7) at the lumbar spine, 2.2% (95% CI 0.5-3.8) at the femoral neck, and 2.8% (95% CI 0.8-4.9) at the total hip; similar gains were found with teriparatide transitioned to 1 year of denosumab. Bisphosphonates followed by 1 year of denosumab resulted in significant BMD gain at the lumbar spine (3.5%, 95% CI 2.8-4.2), femoral neck (1.5%, 95% CI 1.2-1.9), and total hip (2.1%, 95% CI 1.8-2.3). However, bisphosphonates transitioned to 1 year of teriparatide resulted in significant BMD gain at the lumbar spine (5.1%, 95% CI 4.4-5.9) but not at the hip.

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

Indexed as

Bone Density Conservation AgentsOsteoporosisAntibodies, MonoclonalBone DensityDenosumabDiphosphonatesDrug Administration ScheduleDrug Therapy, CombinationHumansLumbar VertebraeOsteoporotic FracturesTeriparatideAntibodies, MonoclonalBone Density Conservation AgentsDenosumabDiphosphonatesromosozumabTeriparatideAnabolicsAntiresorptivesBone mineral densityFracture preventionOsteoporosisSequential therapy

Identifiers

PMID41105226

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.