In severe osteoporosis with recent vertebral compression fracture, drug treatment with anabolic agent in the first 18 months can stimulate the healing process and reduce the rate of progression, preventing new fractures and improving the quality of life of the patient. The sequential therapy with bisphosphonates for at least another 12 months can help to maintain balanced bone turnover markers without the incidence of new fractures. The association of kyphoplasty or vertebroplasty and anti-osteoporotic drugs can be limited by national rules of eligibility. Hence the need for shared treatment protocols.