Osteoporosis refers to the condition when bones become thinner and brittle causing them to fracture easily. Menopause can increase a woman’s risk of developing osteoporosis. The drop in estrogen, a hormone that helps maintain the bone mass results in the increased bone loss. It is estimated that the average woman loses up to 10 percent of her bone mass in the first five years after menopause. Fortunately, preventive treatments are available that can help maintain or increase the bone density. However, usually it requires a long-term treatment and anabolic or vagents are indicated for 18–24 months.

Recently, sequential therapy has been proposed to overcome this problem by giving 2 or more drugs in a sequence. However, whether switching treatment from anabolic to antiresorptive drugs or the reverse could maintain or further increase BMD; and whether the sequential therapy could outperform the monotherapy under the same treatment duration still remains unclear.

A review was performed using medical databases including Medline, Embase and Cochrane library from January 1, 1974 through February 1, 2016. The review included randomised controlled trials evaluating the effectiveness of sequential therapy of antiresorptive and anabolic drugs in postmenopausal osteoporosis women with the BMD changes of the lumbar spine, femoral neck, and total hip as the outcomes. According to the Cochrane Handbook for systematic Reviews of Interventions evaluated the methodological quality and abstracted relevant data. 

Eight published trials involving 1509 patients were included. Pooled analysis data showed that alternative drugs help maintain or increase bone density and also prevent fractures and significantly increase spine BMD percentage at the lumbar spine (MD, 3.59; 95% CI, 2.26–4.93), femoral neck (MD, 1.44; 95% CI, 0.60–2.27), and total hip (MD, 1.24; 95% CI, −0.12 to 2.60). However, change in BMD was not significantly increased at the total hip. The sequential therapy significantly increased BMD from baseline at the lumbar spine (SMD, 0.59; 95% CI, 0.26–0.91), femoral neck (SMD, 0.22; 95% CI, 0.06–0.37), and total hip (SMD, 0.28; 95% CI, 0.01–0.56).

This study lends further support to the ongoing body of evidence about the role of sequential therapy for the treatment of osteoporosis. The study shows the success of sequential therapy for greater improvements in BMD, prevention of bone loss as to compared with any anti-resorptive drug given for the same treatment duration and was as effective as anabolic drugs. However, further research is much needed to determine the long-term significance with this kind of sequential therapy, with a goal to determine the best sequence and the most appropriate drugs of sequential therapy so that patients with osteoporosis should be considered for this treatment option.