[Sequential drug treatments for osteoporosis].

Osteoporosis is a chronic disease requiring lifelong treatment, both non-pharmacological and pharmacological. If life expectancy is long enough, drug treatment must be sequential and adapted to the risk of fracture and to comorbidities. With other treatments than bisphosphonates, sequences are mandatory. When denosumab is stopped, bisphosphonates reduce the rebound effect and limit the risk of vertebral fractures. Osteoanabolic treatments are used for 12 (romosozumab) to 24 months (teriparatide). Their anti-fracture benefits can be maintained with subsequent antiresorptive treatment (bisphosphonates, denosumab), which is an integral part of the management of patients pre-treated with an osteoanabolic agent. Regular monitoring is necessary to assess whether drug treatment should be interrupted, continued, or extended. The aim is to preserve bone health into old age and prevent fractures.