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Romosozumab is associated with greater trabecular bone score improvement compared to denosumab in postmenopausal osteoporosis

 Namki Hong  ;  Sungjae Shin  ;  Seunghyun Lee  ;  Yumie Rhee 
 OSTEOPOROSIS INTERNATIONAL, Vol.34(12) : 2059-2067, 2023-12 
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Issue Date
Cancellous Bone ; Denosumab / pharmacology ; Denosumab / therapeutic use ; Diphosphonates ; Female ; Fractures, Bone* / chemically induced ; Humans ; Lumbar Vertebrae ; Middle Aged ; Osteoporosis, Postmenopausal* / chemically induced ; Osteoporosis, Postmenopausal* / drug therapy ; Selective Estrogen Receptor Modulators
Bone mineral density ; Denosumab ; Osteoporosis ; Postmenopause ; Romosozumab ; Trabecular bone score
In this study, romosozumab demonstrated significantly greater improvement in trabecular bone score compared to denosumab therapy in postmenopausal women previously treated with antiresorptive agents. Notably, in patients previously treated with anti-resorptive agents, treatment with romosozumab resulted in similar increases in trabecular bone score compared to that of drug-naive patients.PurposeRomosozumab significantly increases bone mineral density (BMD) and rapidly reduces fracture risk. Whether romosozumab can improve the spinal trabecular bone score (TBS) as a bone quality indicator merits further investigation.MethodsData for postmenopausal women starting romosozumab or denosumab treatment at Severance Hospital, Korea, were analyzed. Romosozumab and denosumab groups were 1:1 matched using propensity scores, considering relevant covariates. Good responders were defined as those with TBS improvement of 5.8% or greater.ResultsOverall, 174 patients (romosozumab, n = 87; denosumab, n = 87) were analyzed. Matched groups did not differ in age (64 years), weight, height, previous fracture (38%), lumbar spine or femoral neck BMD (T-score, -3.4 and -2.6, respectively), or prior bisphosphonate or selective estrogen receptor modulator (SERM) exposure (50%). The romosozumab group exhibited a greater increase in lumbar spine BMD (15.2% vs. 6.9%, p < 0.001) and TBS (3.7% vs. 1.7%, p = 0.013) than the denosumab group. In patients transitioning from bisphosphonate or SERM, romosozumab users showed greater improvement in TBS compared to denosumab users (3.9% versus 0.8%, P = 0.006); the drug-naive group showed no significant difference (3.6% versus 2.7%, P = 0.472). The romosozumab group had a higher proportion of good responders than the denosumab group (33.3% vs. 18.4%, p = 0.024). Romosozumab therapy for 12 months resulted in 3.8-fold higher odds of a good response in TBS than denosumab after covariate adjustment (adjusted odds ratio 3.85, p = 0.002).ConclusionRomosozumab could improve bone mass and bone quality, measured by TBS, in postmenopausal osteoporosis, particularly as a subsequent regimen in patients previously taking anti-resorptive agents.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Shin, Sung Jae(신성재)
Rhee, Yumie(이유미) ORCID logo https://orcid.org/0000-0003-4227-5638
Hong, Nam Ki(홍남기) ORCID logo https://orcid.org/0000-0002-8246-1956
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