[RESULTS] After 48 months , the primary outcome of mean spine bone mineral density increased by 183 % ( 95 % CI 149-218 ) in 27 women in the teriparatide to denosumab group , 140 % ( 109-172 ) in 27 women the denosumab to teriparatide group , and 160 % ( 140-180 ) in 23 women in the combination to denosumab group , although this increase did not differ significantly between groups ( for between-group comparisons , p = 013 for the teriparatide to denosumab group vs the denosumab to teriparatide group , p = 030 for the teriparatide to denosumab group vs the combination to denosumab group , and p = 041 for the denosumab to teriparatide group vs the combination to denosumab group ) .