Teriparatide (TPTD) – a potent stimulator of bone formation – is a possible, key component of combination therapy. Overall, the findings from clinical studies support the theoretical conviction that the additive synergism between the bone-forming activity of TPTD and the effect of antiresorptive agents surpasses monotherapy with any other agent with regard to effectiveness in increasing bone density. While initial treatment with the concomitant administration of TPTD and estrogen/SERM is clearly superior to monootherapy, considering bisphosphonates, this holds true only for the combination of zolendronate with TPTD, and for the bone density of the hip region. In patients who have been receiving bisphosphonates previously, the first year is the vulnerability period of TPTD therapy. In particular, a decline of BMD should be expected after the discontinuation of the bisphosphonate, and this can be prevented only by well-timed bridging from the latter. In patients receiving TPTD, the integration of antiresorptive agents into the therapeutic regimen enhances the anabolic effect of TPTD on bone. The effectiveness of combination therapy with TPTD and denosumab definitely exceeds that of monotherapy with either component – in all skeletal regions. The efficacy of sequential antiresorptive therapy (with a bisphosphonate or denosumab in clinical practice) has been demonstrated in every skeletal region, both as regards the maintenance and the further increase of BMD gain.

Osteoporosis is an endemic disease in Hungary, similary as occurs in other parts of Europe. The number of patients has been steadily increasing due to the aging of the population and to civilizational harms. The number of fractures related to osteoporosis also increases. Osteoporotic fractures are associated with exessmortality. Effective treatment options are available, which reduce the risk of vertebral and non-vertebral fractures, but the identification of patients with high fracture risk is problematic. The prevention to the the illness (information, way of life, screening, medication) besides resulting in a better quality of life costs less, than do the treatment and rehabilitation of fractures.