Real-world evidence indicates romosozumab use is associated with a greater reduction in osteoporotic fractures than PTH (1-34) analogs in women.
Romosozumab may reduce the risk of osteoporotic fractures more effectively than PTH receptor agonists in certain populations, but further research is needed to confirm these findings and assess long-term outcomes.
Where it sits
this study against the rest of the abaloparatide (tymlos) corpusSummary and findings
This study compared the effectiveness of romosozumab (ROMO) with parathyroid hormone (PTH) receptor agonists, including abaloparatide (APTD), in reducing fracture risk in women with osteoporosis. The analysis involved 2,258 matched pairs and reported lower risks of osteoporotic fractures and hypercalcemia for ROMO users. No therapeutic claims are made.
Abstract
Background To compare the effectiveness of romosozumab (ROMO) with parathyroid hormone (PTH) receptor agonists [teriparatide (TPTD)/abaloparatide (APTD)] in reducing fracture risk following osteoporosis treatment. Methods A TriNetX cohort study assessed fracture and mortality risks using Kaplan-Meier analysis with hazard ratios (HRs) and 95% confidence intervals (CIs). Results After propensity score matching (n = 2,258 pairs), ROMO users had lower risks of osteoporotic fractures (HR: 0.711, 95% CI: 0.542-0.931) and hypercalcemia (HR = 0.707, 95% CI: 0.511-0.977) compared with PTH receptor agonists. Five subgroup analyses demonstrated a reduced fracture risk in the ROMO cohort among women (HR: 0.738), patients aged ≥ 65 years (HR: 0.652), individuals with a history of prior fractures (HR: 0.659), and those without chronic kidney disease (CKD) (HR: 0.731). Sensitivity analyses confirmed the robustness of the findings across different covariate adjustments, data sources, and extended follow-up, consistently showing a lower risk of hypercalcemia and nonsignificant trends toward reduced fracture risk in the ROMO cohort. Conclusion Compared with PTH analogs, ROMO offers stronger short-term protection against osteoporotic fractures and hypercalcemia, particularly in older women with prior fractures. Nonetheless, cardiovascular safety, calcium metabolism, and sequential therapy require careful consideration for individualized treatment.