Real-World Effectiveness of Osteoporosis Treatments on Bone Strength and the Impact of Sequential Anabolic Therapy
- 1Duke University
Abstract
SummaryIn this real-world biomechanical CT analysis study, romosozumab showed greater increases in vertebral bone strength and density than teriparatide and denosumab in treatment-naive women with postmenopausal osteoporosis. Romosozumab also increased bone strength after prior teriparatide, whereas twice-weekly teriparatide failed to maintain gains achieved with prior romosozumab.
PurposeEvidence regarding the comparative effectiveness of osteoporosis treatments in improving bone strength in clinical practice remains limited. This real-world study compared the effectiveness of different osteoporosis treatments in women with postmenopausal osteoporosis (PMO), including treatment-naive patients initiating Romo, TPTD, or DMAb (Study 1) and patients switching from one anabolic therapy to another (Study 2).
MethodsJapanese women with PMO aged >55 years were included. In Study 1, 57, 34, and 50 women received Romo, TPTD, or DMAb, respectively, for 12 months. In Study 2, 16 received Romo for 12 months after TPTD (TPTD-Romo) and 29 received twice-weekly TPTD for 12 months after Romo (Romo-TPTD). The primary and secondary endpoints were average percent change from baseline at 12 months in vertebral bone strength and volumetric BMD (vBMD), respectively, assessed using biomechanical CT analysis (BCT).
ResultsAt baseline, overall bone strength and vBMD were comparable across groups in both studies. In Study 1, average percent change (95% CI) in vertebral strength was highest with Romo (39.5% [34.2, 44.7]), followed by TPTD (24.4% [18.8, 30.0]), and DMAb (10.9% [7.6, 14.2]). In Study 2, vertebral strength increased by 16.1% (10.6, 21.6) with TPTD-Romo, and decreased by 7.7% ( 10.7, 4.6) with Romo-TPTD despite subsequent TPTD treatment. Similar trends were observed for vertebral vBMD.
ConclusionIn this real-world BCT study, Romo showed greater increases in both vertebral bone strength and density versus TPTD and DMAb in treatment-naive women with PMO. Among prior TPTD, Romo further increased bone strength and density; however, twice-weekly TPTD failed to maintain the gains following prior Romo.
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BibTeX
@misc{ishikawa2026realworld,
title = {{Real-World Effectiveness of Osteoporosis Treatments on Bone Strength and the Impact of Sequential Anabolic Therapy}},
author = {K. Ishikawa and T. M. Keaveny and X. Li and Y. Shi and D. C. Lee and S. Tani and T. Towatari and B. D. Elder and P. Passias and M. Oates},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.23.26366354},
url = {https://www.medrxiv.org/content/10.64898/2026.10.23.26366354v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Real-World Effectiveness of Osteoporosis Treatments on Bone Strength and the Impact of Sequential Anabolic Therapy
AU - K. Ishikawa
AU - T. M. Keaveny
AU - X. Li
AU - Y. Shi
AU - D. C. Lee
AU - S. Tani
AU - T. Towatari
AU - B. D. Elder
AU - P. Passias
AU - M. Oates
PY - 2026
DA - 2026/10/23
PB - medRxiv
DO - 10.64898/2026.10.23.26366354
UR - https://www.medrxiv.org/content/10.64898/2026.10.23.26366354v1
AB - SummaryIn this real-world biomechanical CT analysis study, romosozumab showed greater increases in vertebral bone strength and density than teriparatide and denosumab in treatment-naive women with postmenopausal osteoporosis. Romosozumab also increased bone strength after prior teriparatide, whereas twice-weekly teriparatide failed to maintain gains achieved with prior romosozumab. PurposeEvidence regarding the comparative effectiveness of osteoporosis treatments in improving bone strength in clinical practice remains limited. This real-world study compared the effectiveness of different osteoporosis treatments in women with postmenopausal osteoporosis (PMO), including treatment-naive patients initiating Romo, TPTD, or DMAb (Study 1) and patients switching from one anabolic therapy to another (Study 2). MethodsJapanese women with PMO aged >55 years were included. In Study 1, 57, 34, and 50 women received Romo, TPTD, or DMAb, respectively, for 12 months. In Study 2, 16 received Romo for 12 months after TPTD (TPTD-Romo) and 29 received twice-weekly TPTD for 12 months after Romo (Romo-TPTD). The primary and secondary endpoints were average percent change from baseline at 12 months in vertebral bone strength and volumetric BMD (vBMD), respectively, assessed using biomechanical CT analysis (BCT). ResultsAt baseline, overall bone strength and vBMD were comparable across groups in both studies. In Study 1, average percent change (95% CI) in vertebral strength was highest with Romo (39.5% [34.2, 44.7]), followed by TPTD (24.4% [18.8, 30.0]), and DMAb (10.9% [7.6, 14.2]). In Study 2, vertebral strength increased by 16.1% (10.6, 21.6) with TPTD-Romo, and decreased by 7.7% ( 10.7, 4.6) with Romo-TPTD despite subsequent TPTD treatment. Similar trends were observed for vertebral vBMD. ConclusionIn this real-world BCT study, Romo showed greater increases in both vertebral bone strength and density versus TPTD and DMAb in treatment-naive women with PMO. Among prior TPTD, Romo further increased bone strength and density; however, twice-weekly TPTD failed to maintain the gains following prior Romo.
ER -