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Bone and Mineral Metabolism

MON-823 - Sequential Therapy in Osteoporosis: Real-World Outcomes of Zoledronic Acid Following Teriparatide

Monday, June 15, 2026
9:00 AM - 2:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Maria Garcia, MD: No financial relationships to disclose


Background: Teriparatide (TPT) reduces vertebral and non-vertebral fracture risk. To preserve skeletal gains after treatment discontinuation, sequential antiresorptive therapy is recommended; however, evidence guiding optimal strategies remains limited.

Objective: To evaluate changes in bone mineral density (BMD), bone turnover markers (BTM), and fractures one year after zoledronic acid (AZ) in patients who completed 24 months of TPT.

Methods: Retrospective observational study of postmenopausal women with osteoporosis treated with AZ 5 mg after completing TPT. Lumbar spine (LS) and total hip (TH) BMD were measured by DXA. Serum CTX and osteocalcin were assessed, along with fracture history. Patients with secondary osteoporosis were excluded.

Results: Fifteen women were included (mean age 68.5 ± 9.6 years). Most had prevalent fragility fractures and prior antiresorptive exposure. LS BMD increased after TPT and remained stable one year after AZ (pre-TPT p=0.397). TH BMD showed no significant changes throughout treatment. CTX and osteocalcin increased during TPT and decreased after AZ; the reduction in CTX was statistically significant and associated with fracture risk reduction.

Conclusion: In this real-world cohort of high-risk postmenopausal women, zoledronic acid effectively preserved BMD gains achieved with teriparatide and prevented post-anabolic bone loss. These findings support AZ as a valid sequential therapy following TPT and highlight the role of BTM suppression in fracture risk mitigation.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*