Romosozumab does not improve volumetric bone mineral density at distal radius but is associated with early changes in bone strength: a prospective study
- 1Rheumatology Section, Department of Medicine, University of Verona, Pz Scuro 10, Verona, 37134 Italy
- 2Rheumatology Department, Unidade Local de Saúde de São João, Porto, Portugal
- 3RAR Tech Srl Medical Devices, Verona, Italy
Abstract
We evaluated how romosozumab affects bone structure, density, and strength at the wrist over 12 months. Volumetric bone mineral density did not increase, but high-resolution quantitative computed tomography imaging showed modest improvements in bone strength. These findings suggest that romosozumab may improve bone quality even in areas where density changes are not seen with standard scans and highlight the importance of using more detailed imaging to fully understand how osteoporosis treatments work across different skeletal sites.
Purpose: Romosozumab (ROMO) is a monoclonal antibody that inhibits sclerostin, promoting bone formation and suppressing resorption. While ROMO leads to substantial BMD gains at the lumbar spine and the hip, its effects on distal radius volumetric BMD (vBMD) remain unclear. High-resolution peripheral quantitative computed tomography (HR-pQCT) allows for detailed assessment of bone microarchitecture and strength at peripheral regions. We aimed to evaluate the effects of 12 months of ROMO on vBMD, microarchitecture and biomechanical properties of the distal radius using HR-pQCT.
Methods: We did a prospective study on 49 postmenopausal women with osteoporosis treated with ROMO for 12 months who underwent HR-pQCT with Cone Beam CT and microfinite element analysis (uFEA) assessments at baseline, 3, 6, and 12 months. We also performed DXA at lumbar spine, femoral neck, and total hip. HR-pQCT parameters trajectories were analyzed using mixed-effects modeling.
Results: No significant increases were observed in cortical or trabecular vBMD or microarchitectural parameters at the distal radius. On the other hand, uFEA showed early increases in cortical failure load and shear strength, suggesting potentially improved bone mechanical behavior. Lumbar spine, femoral neck, and total hip aBMD significantly increased by 11.6%, 8.3%, and 3.1%, respectively (all p < 0.001).
Conclusion: ROMO treatment was associated with modest early changes in biomechanical parameters, without significant improvement in vBMD at the distal radius. ROMO treatment might improve skeletal health beyond BMD gains.
Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s00198-026-08113-3.
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BibTeX
@article{dizlopes2026romosozumab,
title = {{Romosozumab does not improve volumetric bone mineral density at distal radius but is associated with early changes in bone strength: a prospective study}},
author = {Mariana Diz-Lopes and Caterina Fanti Rovetta and Francesco Pollastri and Francesca Mastropaolo and Rosanna Somma and Mattia Tugnolli and Emma Pasetto and Camilla Benini and Valeria Messina and Angelo Fassio and Davide Gatti and Ombretta Viapiana and Enrico Grendene and Pierluigi Mozzo and Maurizio Rossini and Giovanni Adami},
journal = {Osteoporosis International},
year = {2026},
month = jun,
doi = {10.1007/s00198-026-08113-3},
url = {https://doi.org/10.1007/s00198-026-08113-3},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Romosozumab does not improve volumetric bone mineral density at distal radius but is associated with early changes in bone strength: a prospective study
AU - Mariana Diz-Lopes
AU - Caterina Fanti Rovetta
AU - Francesco Pollastri
AU - Francesca Mastropaolo
AU - Rosanna Somma
AU - Mattia Tugnolli
AU - Emma Pasetto
AU - Camilla Benini
AU - Valeria Messina
AU - Angelo Fassio
AU - Davide Gatti
AU - Ombretta Viapiana
AU - Enrico Grendene
AU - Pierluigi Mozzo
AU - Maurizio Rossini
AU - Giovanni Adami
PY - 2026
DA - 2026/06/18
JO - Osteoporosis International
DO - 10.1007/s00198-026-08113-3
UR - https://doi.org/10.1007/s00198-026-08113-3
AB - We evaluated how romosozumab affects bone structure, density, and strength at the wrist over 12 months. Volumetric bone mineral density did not increase, but high-resolution quantitative computed tomography imaging showed modest improvements in bone strength. These findings suggest that romosozumab may improve bone quality even in areas where density changes are not seen with standard scans and highlight the importance of using more detailed imaging to fully understand how osteoporosis treatments work across different skeletal sites. Purpose: Romosozumab (ROMO) is a monoclonal antibody that inhibits sclerostin, promoting bone formation and suppressing resorption. While ROMO leads to substantial BMD gains at the lumbar spine and the hip, its effects on distal radius volumetric BMD (vBMD) remain unclear. High-resolution peripheral quantitative computed tomography (HR-pQCT) allows for detailed assessment of bone microarchitecture and strength at peripheral regions. We aimed to evaluate the effects of 12 months of ROMO on vBMD, microarchitecture and biomechanical properties of the distal radius using HR-pQCT. Methods: We did a prospective study on 49 postmenopausal women with osteoporosis treated with ROMO for 12 months who underwent HR-pQCT with Cone Beam CT and microfinite element analysis (uFEA) assessments at baseline, 3, 6, and 12 months. We also performed DXA at lumbar spine, femoral neck, and total hip. HR-pQCT parameters trajectories were analyzed using mixed-effects modeling. Results: No significant increases were observed in cortical or trabecular vBMD or microarchitectural parameters at the distal radius. On the other hand, uFEA showed early increases in cortical failure load and shear strength, suggesting potentially improved bone mechanical behavior. Lumbar spine, femoral neck, and total hip aBMD significantly increased by 11.6%, 8.3%, and 3.1%, respectively (all p < 0.001). Conclusion: ROMO treatment was associated with modest early changes in biomechanical parameters, without significant improvement in vBMD at the distal radius. ROMO treatment might improve skeletal health beyond BMD gains. Supplementary information: The online version contains supplementary material available at https://doi.org/10.1007/s00198-026-08113-3.
SN - 0937-941X
SN - 1433-2965
ER -