#2-90E. Beyond Bisphosphonates: Optimizing Sequential Therapy in Osteoporosis (Best Pract Res Clin Rheumatol, 2025)

How should clinicians optimize fracture prevention in high-risk patients amidst a rapidly evolving therapeutic landscape? This episode explores the 2025 clinical update "Novel therapies in osteoporosis," which outlines the paradigm shift from traditional antiresorptives to advanced anabolic agents like romosozumab and parathyroid hormone analogs. The review comprehensively details the mechanisms and efficacy of these novel pharmacotherapies, specifically addressing their use in rheumatological populations. The most critical clinical takeaway is the strong evidence supporting sequential therapy—initiating treatment with potent anabolic agents followed by antiresorptives—as the superior strategy for maximizing bone mineral density in very high-risk patients. While this "treat-to-target" approach offers superior outcomes, the paper critically emphasizes the necessity of managing safety profiles, particularly cardiovascular risks associated with sclerostin inhibitors and the rebound fracture risk upon denosumab discontinuation. For listening physicians, this analysis provides essential guidance on risk stratification and constructing personalized therapeutic sequences to bridge the treatment gap in osteoporosis management.

Citation: INDERJEETH, C. and INDERJEETH, D.C. Novel therapies in osteoporosis – Clinical update – 2025. Best Practice & Research Clinical Rheumatology. 39, 102100, 2025. DOI: 10.1016/j.berh.2025.102100

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.