, Volume 64, Issue 3, pp 441–455 | Cite as

The next step after anti-osteoporotic drug discontinuation: an up-to-date review of sequential treatment

  • Núria GuañabensEmail author
  • María Jesús Moro-Álvarez
  • Enrique Casado
  • Josep Blanch-Rubió
  • Carlos Gómez-Alonso
  • Guillermo Martínez Díaz-Guerra
  • Javier del Pino-Montes
  • Carmen Valero Díaz de Lamadrid
  • Pilar Peris
  • Manuel Muñoz-Torres
  • SEIOMM Working Group


Several antiresorptive drugs, like bisphosphonates and denosumab, are currently available for the treatment of osteoporosis due to their evidenced efficacy in reducing fracture risk at mid-term. Osteoanabolic therapies, like teriparatide, whose treatment duration is limited to 2 years, have also shown efficacy in the reduction of fracture risk. However, depending on the severity of osteoporosis and the presence of other associated risk factors for fracture, some patients may require long-term treatment to preserve optimal bone strength and minimize bone fracture risk. Given the limited duration of some treatments, the fact that most of the antiresorptive drugs have not been assessed beyond 10 years, and the known long-term safety issues of these drugs, including atypical femoral fractures or osteonecrosis of the jaw, the long-term management of these patients may require an approach based on drug discontinuation and/or switching. In this regard, interest in sequential osteoporosis therapy, wherein drugs are initiated and discontinued over time, has grown in recent years, although the establishment of an optimal and individualized order of therapies remains controversial. This review reports the currently available clinical evidence on the discontinuation effects of different anti-osteoporotic drugs, as well as the clinical outcomes of the different sequential treatment regimens. The objective of this article is to present up-to-date practical knowledge on this area in order to provide guidance to the clinicians involved in the management of patients with osteoporosis.


Osteoporosis Drug discontinuation Sequential treatment Parathyroid hormone Bisphosphonates Denosumab 



We thank the following for permission to reproduce the figures that have appeared in published material: Journal of Bone and Mineral Research (John Wiley and Sons) for permission to reproduce Fig. 1 in Cummings et al. [63]; Ogilvy Healthworld Barcelona provided medical writing services (funded by Sociedad Española de Investigación Ósea y del Metabolismo Mineral, SEIOMM).

Compliance with ethical standards

Conflict of interest

Dr. N.G. has received fees for lectures and participation in advisory boards from Amgen, Eli Lilly, Alexion, and UCB. Dr. E.C. has received fees for lectures and/or participation in advisory boards from Amgen, Lilly, UCB and Rubió. Dr. J.B.-R. has received advisory fees from Amgen and Gebro Pharma. Dr. C.G.-A. has received fees for lectures and participation in advisory boards from Amgen, Eli Lilly, Faes, Gebro, and UCB. Dr. G.M.D.-G. holds a research grant from Amgen and Shire, has received advisory fees from Amgen, UCB, Eli Lilly, and Shire and speaker honoraria from Amgen and Eli Lilly. Dr. J.d.P.-M. has received advisory and conference fees, as well as congress grants from Amgen, UCB, and FAES and conference fees from Eli Lilly and Gebro. Dr. P.P. has received lecture fees from Amgen, Eli Lilly, Alexion, and Kyowa Kirin. Dr. M.M.-T. has received fees for lectures and advisory boards from Amgen, UCB, Eli Lilly, Alexion, Shire, and Kyowa Kirin.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Núria Guañabens
    • 1
    Email author
  • María Jesús Moro-Álvarez
    • 2
  • Enrique Casado
    • 3
  • Josep Blanch-Rubió
    • 4
  • Carlos Gómez-Alonso
    • 5
  • Guillermo Martínez Díaz-Guerra
    • 6
  • Javier del Pino-Montes
    • 7
  • Carmen Valero Díaz de Lamadrid
    • 8
  • Pilar Peris
    • 1
  • Manuel Muñoz-Torres
    • 9
    • 10
  • SEIOMM Working Group
  1. 1.Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)University of BarcelonaBarcelonaSpain
  2. 2.Bone Metabolism, Internal MedicineUniversity Hospital Infanta LeonorMadridSpain
  3. 3.Rheumatology Department, Parc Taulí University HospitalAutonomous University of BarcelonaSabadellSpain
  4. 4.Rheumatology ServiceHospital del MarBarcelonaSpain
  5. 5.Bone and Mineral Metabolism Unit, Central University Hospital of Asturias (HUCA)University of OviedoOviedoSpain
  6. 6.Endocrinology Service, University Hospital 12 de OctubreComplutense UniversityMadridSpain
  7. 7.University Hospital of Salamanca/University of SalamancaSalamancaSpain
  8. 8.University Hospital Marqués de Valdecilla, Research Institute Marqués de Valdecilla (IDIVAL)University of CantabriaSantanderSpain
  9. 9.Endocrinology and Nutrition Unit, Hospital Universitario San Cecilio de Granada, Department of MedicineUniversity of GranadaGranadaSpain
  10. 10.Instituto de Investigación Biosanitaria (Ibs.GRANADA)CIBERFES, Instituto de Salud Carlos IIIGranadaSpain

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