Osteoporosis care has seen major advances through clinical trials and the development of bone-targeted therapies. Yet, conventional treatment approaches rely on short-term, single-agent regimens, overlooking the complexity of long-term management—sequential therapy, treatment cessation, and individual variability in response. This presentation will explore real-world insights in sequential and combination therapies in osteoporosis, ethnic variations in skeletal drug response, bone loss following acute spinal cord injury, and the establishment of the Westmead Hospital Fracture Liaison Service, a service designed to support high-risk and underserved populations in Western Sydney.