Real-world comparison of abaloparatide and romosozumab: effects on bone mineral density and three-dimensional hip structure.
Both abaloparatide and romosozumab significantly improved bone mineral density in postmenopausal women with high-risk osteoporosis over 12 months, with no significant differences between the two treatments.
Where it sits
this study against the rest of the abaloparatide (tymlos) corpusSummary and findings
This study measured the effects of abaloparatide and romosozumab on bone mineral density (BMD) and three-dimensional hip structure in postmenopausal women with high-risk osteoporosis over 12 months. Both treatments resulted in significant improvements in BMD, with no significant differences between the two groups. The study included 51 matched patients in each treatment group.
Abstract
In a real-world study of postmenopausal women with high-risk osteoporosis, abaloparatide and romosozumab significantly improved bone mineral density and threedimensional hip structural parameters over 12 months, with no significant between-group differences observed.<h4>Purpose</h4>Direct real-world comparisons between abaloparatide and romosozumab, particularly incorporating structural assessment beyond areal bone mineral density (BMD), remain limited.<h4>Methods</h4>This nationwide multicenter propensity score-matched cohort study compared the effects of abaloparatide and romosozumab on BMD and three-dimensional proximal femur structural parameters in treatment-naïve postmenopausal women with osteoporosis at high fracture risk. Fifty-one matched patients were included in each group. Primary endpoints were percentage changes in lumbar spine (LS), total hip (TH), and femoral neck (FN) BMD over 12 months. Secondary and exploratory endpoints included achievement of T-score thresholds, bone turnover markers, and DXA-based 3D-Shaper structural parameters. Longitudinal changes were assessed using mixed models for repeated measures.<h4>Results</h4>Both groups demonstrated significant increases in BMD at all skeletal sites at 12 months (all P < 0.001), with no significant between-group differences. The proportion of patients achieving a T-score > -2.5 increased over time in both groups without significant between-group differences. Exploratory 3D-Shaper analyses demonstrated improvements in several trabecular and cortical structural parameters over 12 months, with no significant between-group differences in any parameter.<h4>Conclusion</h4>In this real-world propensity score-matched cohort, abaloparatide and romosozumab significantly improved BMD and proximal femur structural parameters over the first 12 months of treatment. No significant between-group differences were observed during this period.
Background
This paper addresses the comparative effects of abaloparatide and romosozumab on bone mineral density and hip structure in postmenopausal women with high-risk osteoporosis. Prior studies have shown that both medications can improve bone density, but direct comparisons, especially with structural assessments, are limited. Understanding the relative effectiveness of these treatments is important for optimizing osteoporosis management.
Methods
This was a nationwide multicenter propensity score-matched cohort study involving treatment-naïve postmenopausal women with osteoporosis at high fracture risk. A total of 102 patients were included, with 51 matched patients receiving abaloparatide and 51 receiving romosozumab. The primary endpoints were percentage changes in lumbar spine, total hip, and femoral neck BMD over 12 months, assessed using mixed models for repeated measures.
Results
Both treatment groups demonstrated significant increases in BMD at all skeletal sites at 12 months, with all P-values reported as < 0.001. There were no significant between-group differences in BMD changes or in the proportion of patients achieving T-score thresholds. Exploratory analyses indicated improvements in several trabecular and cortical structural parameters, again with no significant between-group differences.
Interpretation
The results indicate that both abaloparatide and romosozumab effectively improve bone mineral density in a real-world setting, consistent with prior literature. However, the lack of significant between-group differences suggests that either treatment may be similarly effective, raising questions about the clinical significance of choosing one over the other. Limitations such as potential confounding factors and the observational nature of the study may affect the robustness of these conclusions.
Key findings
- Significant increases in lumbar spine BMD at 12 months, P < 0.001.
- Significant increases in total hip BMD at 12 months, P < 0.001.
- Significant increases in femoral neck BMD at 12 months, P < 0.001.
- No significant between-group differences in BMD changes.
- Proportion of patients achieving T-score > -2.5 increased over time in both groups without significant between-group differences.
Limitations
- No significant between-group differences observed.
- Real-world study may include confounding factors.
- Sample size of 102 may limit generalizability.
- Short follow-up duration of 12 months.