Our bones are a limited resource. Osteoporosis—the most common bone-weakening disease—affects 10 million older people a year in the United States alone. Studies have shown that anabolic osteoporosis therapies, which stimulate the body’s natural tissue-forming processes, can bring bone mass closer to normal levels. But without follow-up anti-resorptive medications, which slow natural bone breakdown, the beneficial effects of treatment disappear.
However, a new study led by researchers from the University of Maryland Institute for Health Computing (UM-IHC) and the Mayo Clinic reveals that two-thirds of patients receiving anabolic treatment are not appropriately transitioned to the crucial anti-resorptive therapy afterward. The study was published this week in the journal JAMA Internal Medicine.
“This is a severe gap in care nationally that has until now been under-recognized,” said a study principal investigator, Rozalina McCoy, director of UM-IHC’s Center for Population Health and an associate professor of medicine in the University of Maryland School of Medicine. “Follow-up therapy is essential to preserve bone density gains and prevent future fractures,” she said. “Without it, patients who have been invested in and who have benefited from treatment will likely lose significant ground, their treatment gains reversed.”
Finding fractures in care
Every three seconds, someone in the world breaks a bone due to osteoporosis. Of the 10 million people aged 50 and older in the United States with the disease, 80% of them are women and half of them will sustain a fracture because of this condition.
In a step toward improving these odds, the researchers examined real-world clinical practice patterns across the United States, using more than 68,000 deidentified insurance claims from between 2009 and 2022. The data showed that about half of osteoporosis patients received no anti-resorptive follow-up therapy after their original treatment, and only 27% received it correctly and within three months of treatment. This is despite consistent guidelines from the Endocrine Society and others, and the FDA’s approved sequence requiring timely follow-up anti-resorptive therapy.
The gap in care has broad clinical and public health ramifications.
“This is a major missed opportunity to improve outcomes and reduce hip fractures in particular, which carry a substantial morbidity, mortality and economic burden,” McCoy said.
This is an actionable gap, according to McCoy, who stressed that interventions to improve post-anabolic management are warranted to enhance future clinical outcomes.
“Patients also need to know that when they start osteoanabolic therapy, they will have to follow that course with anti-resorptive therapy—no matter what,” she said.
Physicians should discuss the available effective osteoporosis treatment options with patients, McCoy said, to ensure they derive the greatest benefit with the least harm and the lightest treatment burden. She and her colleagues are also developing a shared decision-making guide to support these conversations in clinical practice.
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The paper, “Antiresorptive Consolidation After Osteoanabolic Therapy,” by Sanaa Badour, Rozalina G. McCoy, Mark Takagi, Alexander O. Everhart, Joseph Parimi, Jeph Herrin, Pinar Karaca-Mandic, and Juan P. Brito, was published in JAMA Internal Medicine on January 26, 2026.
This research was supported by the National Institutes of Health’s National Institute on Aging (Grant R01AG079113). This article does not necessarily reflect the view of this organization.
