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This study investigated whether combining Strontium (Sr) surface loading (modified alkali and heat treatment) with systemic teriparatide administration could enhance implant osseointegration in osteoporotic conditions. Mouse osteoblast\u2010like cells (MC3T3\u2010E1) were cultured on Sr\u2010loaded Ti surfaces with and without teriparatide administration to evaluate cell adhesion, proliferation, differentiation, and mineralization capacity. This in\u00a0vivo study utilized an osteoporotic rabbit femur through ovariectomy and steroid administration. The combined treatment (Sr\u2010loaded Ti and teriparatide) enhanced osteoblast differentiation and mineralization in\u00a0vitro, with an increase in alkaline phosphatase activity and alizarin red staining. Six and twelve weeks after in\u00a0vivo implantation, the combination therapy demonstrated superior outcomes compared to the single treatments (Sr\u2010loaded Ti or teriparatide), including enhanced bone\u2013implant interfacial strength, improved bone morphology parameters, higher mineral apposition rates, and greater bone\u2013implant contact. These findings demonstrate that the synergistic approach of Sr\u2010loaded Ti implants combined with systemic teriparatide administration considerably improves implant osseointegration in osteoporotic bone, suggesting a promising strategy for enhancing implant outcomes in patients with osteoporotic bone quality.<\/jats:p>","DOI":"10.1002\/jbm.a.37960","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T02:26:22Z","timestamp":1751595982000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Strontium\u2010Loaded Titanium and Systemic Teriparatide Synergistically Enhance Osteogenesis and Osseointegration in an Osteoporotic Rabbit Model"],"prefix":"10.1002","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1315-4565","authenticated-orcid":false,"given":"Koichiro","family":"Shima","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Kyoto University 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