{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:43:14Z","timestamp":1787071394896,"version":"build-2736575974"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>Currently available agents improve bone mineral density (BMD) values on their own in monotherapy but may not completely restore microarchitecture and the patient may continue to sustain fragility fractures. Current monotherapies can only address either increased bone resorption or decreased bone formation. In this setting, combination therapy with antiresorptive and anabolic agents appears to be a promising option. A 49-year-old premenopausal woman presented with severe low backache associated with significant height loss. Evaluation elsewhere revealed severe osteoporosis, which prompted treatment with three doses of parenteral zoledronate 4 mg annually, followed by oral alendronate 70 mg once weekly for 7 years. However, her symptoms persisted despite treatment, and investigations done at our center confirmed severe osteoporosis, with multiple vertebral compression fractures. She was initiated on teriparatide therapy but despite 1 year of treatment, there was persistent height loss. In addition, there was a marked elevation of bone resorption, which prompted us to add denosumab which was administered subcutaneously every 6 months. On follow-up, there was marked relief from pain, no further decrease in height, and progressive improvement in BMD, and bone turnover markers were noted. A dual therapy with anabolic agent teriparatide and antiresorptive agent denosumab for osteoporosis may be a viable option in individuals with severe osteoporosis who do not respond well to a single agent.<\/jats:p>","DOI":"10.4103\/jmh.jmh_168_20","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T09:12:05Z","timestamp":1611220325000},"page":"260-263","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Severe Idiopathic Osteoporosis in a Premenopausal Woman: A Case for Dual Therapy"],"prefix":"10.4103","volume":"11","author":[{"given":"Sudarsanababu Lalitha","family":"Soumya","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kripa Elizabeth","family":"Cherian","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Vizhalil","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"R1-20250922","first-page":"569","article-title":"NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000: highlights of the conference","volume":"94","year":"2001","journal-title":"South Med J"},{"key":"R2-20250922","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4158\/GL-2020-0524SUPPL","article-title":"American Association of Clinical Endocrinologists\/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis\u20132020 update","volume":"26","author":"Camacho","year":"2020","journal-title":"Endocr Pract"},{"key":"R3-20250922","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1056\/NEJMoa031975","article-title":"The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis","volume":"349","author":"Black","year":"2003","journal-title":"N Engl J Med"},{"key":"R4-20250922","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1056\/NEJMoa035725","article-title":"The effects of parathyroid hormone, alendronate, or both in men with osteoporosis","volume":"349","author":"Finkelstein","year":"2003","journal-title":"N Engl J Med"},{"key":"R5-20250922","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/S0140-6736(13)60856-9","article-title":"Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: The DATA study randomised trial","volume":"382","author":"Tsai","year":"2013","journal-title":"Lancet"},{"key":"R6-20250922","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/jbmr.2315","article-title":"Comparative effects of teriparatide, denosumab, and combination therapy on peripheral compartmental bone density, microarchitecture, and estimated strength: The DATA-HRpQCT study","volume":"30","author":"Tsai","year":"2015","journal-title":"J Bone Miner Res"}],"container-title":["Journal of Mid-life Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jmh.JMH_168_20","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:45:30Z","timestamp":1787067930000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jmh.JMH_168_20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":6,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.4103\/jmh.jmh_168_20","relation":{},"ISSN":["0976-7800","0976-7819"],"issn-type":[{"value":"0976-7800","type":"print"},{"value":"0976-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]},"assertion":[{"value":"2020-07-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}