Real-World Effectiveness of Osteoporosis Treatments on Bone Strength and the Impact of Sequential Anabolic Therapy

Romosozumab appears to be more effective than teriparatide in increasing bone strength in postmenopausal women with osteoporosis, but the study's limitations should be considered.

Summary and findings

This study evaluated the effectiveness of osteoporosis treatments on bone strength in postmenopausal women. It compared romosozumab, teriparatide, and denosumab over 12 months. The findings indicated that romosozumab led to greater increases in bone strength compared to teriparatide.

Abstract

<h4>Summary</h4> In this real-world biomechanical CT analysis study, romosozumab showed greater increases in vertebral bone strength and density than teriparatide and denosumab in treatment-naïve women with postmenopausal osteoporosis. Romosozumab also increased bone strength after prior teriparatide, whereas twice-weekly teriparatide failed to maintain gains achieved with prior romosozumab. <h4>Purpose</h4> Evidence 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-naïve patients initiating Romo, TPTD, or DMAb (Study 1) and patients switching from one anabolic therapy to another (Study 2). <h4>Methods</h4> Japanese 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). <h4>Results</h4> At 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. <h4>Conclusion</h4> In this real-world BCT study, Romo showed greater increases in both vertebral bone strength and density versus TPTD and DMAb in treatment-naïve 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.

Limitations

Not reported in abstract.

Elsewhere in the Teriparatide (PTH 1-34) corpus