TOPLINE:

Timely antiresorptive therapy was received by fewer than one third of patients aged 50 years or older within 3 months after osteoanabolic treatment. Despite guidelines advising it, 49.7% of patients had no consolidation.

METHODOLOGY:

• For patients at high risk for fractures, guidelines recommend osteoanabolic therapies followed by consolidation with antiresorptive medications to preserve bone mineral density (BMD) gains and maintain fracture protection.
• Researchers utilized de-identified claims from the OptumLabs Data Warehouse spanning 2009 to 2022 to assess clinical consolidation practices among 68,209 adults aged 50 years or older (mean age, 72.5 years; 91% women; 85.6% White) who started osteoanabolic therapy between 2011 and 2021.
• Baseline demographics, type of insurance, location, prior fracture, and treatments and their durations were recorded.
• The primary outcome was timely consolidation, defined as the initiation of antiresorptive therapy within 3 months post-osteoanabolic treatment.
• Secondary outcomes were delayed consolidation, the restart of osteoanabolic therapy after an interruption of more than 3 months, and no consolidation.

TAKEAWAY:

• Teriparatide was the most used osteoanabolic agent (72.9%), and agents used in prior osteoporosis treatments included oral bisphosphonates (26.9%), denosumab (12.0%), and zoledronate (3.5%).
• Overall, 27% of patients received timely antiresorptive therapy within 3 months post-osteoanabolic treatment.
• Delayed consolidation was observed in 13.4% of patients, and 49.7% had no consolidation after therapy. Moreover, 9.8% restarted osteoanabolic therapy after a gap.
• Romosozumab had the highest rate of timely consolidation, at 55.6%, with timely consolidation rates of 26.5% for abaloparatide and 20.8% for teriparatide. Timely consolidation rates improved over time from 2011 to 2021.

IN PRACTICE:

“The findings of this cohort study suggest that, despite guideline recommendations emphasizing timely consolidation with antiresorptive therapy to preserve BMD gains and reduce fracture risk, clinical implementation has been limited, with considerable gaps in timely consolidation. Interventions to improve postanabolic management may be warranted to improve long-term fracture protection,” the authors wrote.

SOURCE:

The study was led by Sanaa Badour, MD, MSc, University of Florida in Gainesville, Florida. It was published online on January 26, 2026, as a research letter in JAMA Internal Medicine.

LIMITATIONS:

The study could not determine the appropriateness of nonconsolidation or the reasons behind patients not receiving consolidated therapy. The findings may not be generalizable to uninsured individuals or those with coverage lapses.

DISCLOSURES:

The study was supported by grants from the National Institute on Aging of the National Institutes of Health. Some authors disclosed grants from the National Institutes of Health and other organizations and/or reported receiving personal fees during or outside the conduct of the study. One of the authors reported equity and an executive position with XanthosHealth.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.