Association of baseline glycaemic status with BMD change after 12 doses of romosozumab: a retrospective cohort study of 170 patients
11 affiliations
- 1Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- 2Department of Medicine, Queen Mary Hospital
- 3Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
- 4Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- 5Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
- 6Department of Medicine, Tung Wah Hospital
- 7Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital
- 8Duke-NUS Medical School
- 9Asia Pacific Consortium on Osteoporosis (APCO)
- 10Division of Endocinology, Diabetes, and Bone Diseases, Department of Medicine III, Technische Universität Dresden Medical Center
- 11Center for Healthy Aging, Technische Universität Dresden Medical Center
Abstract
Objective: We evaluated whether dysglycaemia is an independent factor associated with bone mineral density (BMD) gain during romosozumab treatment.
Methods: We included all patients who initiated and received 12 doses of romosozumab in two Osteoporosis Centres from January 2019 to March 2025 and had dual-energy X-ray absorptiometry performed at baseline and upon completion of romosozumab. The cohort was divided into three groups. Diabetes was defined by physician diagnosis, glycated haemoglobin (HbA1c) ≥ 6.5%, or anti-diabetic medication use. Among those without known diabetes, HbA1c 5.7%–6.4% defined prediabetes and HbA1c ≤ 5.6% defined normoglycaemia. Percentage of BMD (%BMD) gain while on romosozumab was calculated. Multivariable linear regression analysis was used to identify independent factors associated with %BMD gain.
Results: A total of 170 patients were included (age 71.6 ± 9.6 years; 167 women, 3 men; body mass index (BMI) 21.0 ± 3.6 kg/m ² ): 59.4% had normoglycaemia, 25.9% prediabetes, and 14.7% diabetes (all type 2). Of these, 64.1% had prior antiresorptive exposure. Baseline mean BMD T-scores (95% CI) were −3.0 (−3.2, −2.9) (lumbar spine, LS), −2.9 (−3.1, −2.8) (femoral neck, FN), and −2.6 (−2.7, −2.4) (total hip, TH). In total, 69.4% had prior fractures. Overall %BMD gain was 12.1% (95% CI 10.5%–13.7%) (LS), 3.6% (95% CI 2.4%–4.7%) (FN), and 3.4% (95% CI 2.5%–4.3%) (TH). Across the three glycaemic categories, %BMD gain did not differ (LS: p = 0.821; FN: p = 0.776; TH: p = 0.985). HbA1c did not correlate with %BMD gain. Baseline BMD T-score and prior antiresorptive treatment were the independent factors inversely associated with %BMD gain.
Conclusion: This real-world study showed BMD gains of 12% at the LS and 3.5% at the hip with 12 doses of romosozumab. No statistically significant association was identified between baseline glycaemic category and one-year BMD change during romosozumab treatment. However, the relatively small diabetes subgroup limits the precision of this estimate.
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BibTeX
@article{tsoi2026association,
title = {{Association of baseline glycaemic status with BMD change after 12 doses of romosozumab: a retrospective cohort study of 170 patients}},
author = {Kimberly H. Tsoi and Xi Xiong and Xiaodong Liu and Chun-Ho Wong and Carol H. Y. Fong and Matrix M. H. Fung and Eunice K. H. Leung and Alan C. H. Lee and Tai-Pang Ip and Kathryn C. B. Tan and Chi-Ho Lee and Yu-Cho Woo and Manju Chandran and Elena Tsourdi and David T. W. Lui},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1941784},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1941784/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of baseline glycaemic status with BMD change after 12 doses of romosozumab: a retrospective cohort study of 170 patients
AU - Kimberly H. Tsoi
AU - Xi Xiong
AU - Xiaodong Liu
AU - Chun-Ho Wong
AU - Carol H. Y. Fong
AU - Matrix M. H. Fung
AU - Eunice K. H. Leung
AU - Alan C. H. Lee
AU - Tai-Pang Ip
AU - Kathryn C. B. Tan
AU - Chi-Ho Lee
AU - Yu-Cho Woo
AU - Manju Chandran
AU - Elena Tsourdi
AU - David T. W. Lui
PY - 2026
DA - 2026/10/14
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1941784
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1941784/full
AB - Objective: We evaluated whether dysglycaemia is an independent factor associated with bone mineral density (BMD) gain during romosozumab treatment. Methods: We included all patients who initiated and received 12 doses of romosozumab in two Osteoporosis Centres from January 2019 to March 2025 and had dual-energy X-ray absorptiometry performed at baseline and upon completion of romosozumab. The cohort was divided into three groups. Diabetes was defined by physician diagnosis, glycated haemoglobin (HbA1c) ≥ 6.5%, or anti-diabetic medication use. Among those without known diabetes, HbA1c 5.7%–6.4% defined prediabetes and HbA1c ≤ 5.6% defined normoglycaemia. Percentage of BMD (%BMD) gain while on romosozumab was calculated. Multivariable linear regression analysis was used to identify independent factors associated with %BMD gain. Results: A total of 170 patients were included (age 71.6 ± 9.6 years; 167 women, 3 men; body mass index (BMI) 21.0 ± 3.6 kg/m ² ): 59.4% had normoglycaemia, 25.9% prediabetes, and 14.7% diabetes (all type 2). Of these, 64.1% had prior antiresorptive exposure. Baseline mean BMD T-scores (95% CI) were −3.0 (−3.2, −2.9) (lumbar spine, LS), −2.9 (−3.1, −2.8) (femoral neck, FN), and −2.6 (−2.7, −2.4) (total hip, TH). In total, 69.4% had prior fractures. Overall %BMD gain was 12.1% (95% CI 10.5%–13.7%) (LS), 3.6% (95% CI 2.4%–4.7%) (FN), and 3.4% (95% CI 2.5%–4.3%) (TH). Across the three glycaemic categories, %BMD gain did not differ (LS: p = 0.821; FN: p = 0.776; TH: p = 0.985). HbA1c did not correlate with %BMD gain. Baseline BMD T-score and prior antiresorptive treatment were the independent factors inversely associated with %BMD gain. Conclusion: This real-world study showed BMD gains of 12% at the LS and 3.5% at the hip with 12 doses of romosozumab. No statistically significant association was identified between baseline glycaemic category and one-year BMD change during romosozumab treatment. However, the relatively small diabetes subgroup limits the precision of this estimate.
SN - 1664-2392
ER -