94 postmenopausal women with osteoporosis were randomized to receive either teriparatide, denosumab, or a combination of the two treatments. The purpose of this study was to determine the effectiveness of combined therapy with regards to bone microarchitecture and estimated strength. Findings indicated that combination therapy of teriparatide and denosumab significantly improved most volumetric bone mineral density outcomes, tissue mineral density, cortical thickness, and cortical porosity at both the tibia and radius compared to the denosumab-only and teriparatide-only monotherapy groups after the 24-month follow-up.