Efficacy and Safety of Romosozumab vs Teriparatide in Osteoporotic Postmenopausal Women
Overview
This observational study compared romosozumab (ROMO) and teriparatide (TPTD) in 315 postmenopausal women with osteoporosis. After 12 months, ROMO demonstrated significantly greater increases in bone mineral density (BMD) at the femoral neck, total hip, and lumbar spine, with lower discontinuation and cardiovascular adverse event rates than TPTD.
Background
Osteoporosis affects a significant portion of the global population, increasing fracture risk and morbidity. Bone-anabolic agents like teriparatide, a parathyroid hormone analog, and romosozumab, an anti-sclerostin antibody, have been approved for severe osteoporosis treatment. ROMO uniquely stimulates bone formation while inhibiting resorption, whereas TPTD increases both formation and resorption. Prior studies have shown both agents reduce fracture risk, but direct real-world comparisons are limited.
Data Highlights
Parameter
Romosozumab (ROMO)
Teriparatide (TPTD)
P-value
BMD % Change at Femoral Neck (FN)
4.8%
0.2%
< .001
BMD % Change at Total Hip (TH)
5.7%
0.3%
< .001
BMD % Change at Lumbar Spine (LS)
13.7%
9.3%
< .001
Discontinuation Rate
Lower
Higher
Not specified
Cardiovascular Adverse Events
Lower incidence
Higher incidence
Not specified
Key Findings
Romosozumab led to significantly larger BMD increases at FN, TH, and LS after 12 months compared to teriparatide.
Discontinuation rates were lower with romosozumab, indicating better treatment adherence.
Romosozumab was associated with fewer cardiovascular adverse events than teriparatide.
Treatment-naïve patients showed nonsignificantly higher BMD gains than previously treated patients for both drugs.
Romosozumab’s dual mechanism of stimulating bone formation and inhibiting resorption may underlie its superior efficacy.
Teriparatide increases bone formation but also bone resorption, potentially limiting net BMD gains.
Clinical Implications
Romosozumab should be considered a preferred anabolic treatment option in postmenopausal women with osteoporosis due to its superior BMD improvements and better safety profile, particularly regarding cardiovascular risk. Clinicians should evaluate cardiovascular history before initiating romosozumab, as it is contraindicated in patients with prior myocardial infarction or stroke. Teriparatide remains an alternative, especially where romosozumab is contraindicated or unavailable.
Conclusion
In a real-world clinical setting, romosozumab demonstrated greater efficacy and safety compared to teriparatide in increasing BMD among osteoporotic postmenopausal women. These findings support romosozumab as a valuable treatment option with higher adherence and fewer cardiovascular adverse events.
References
Aarhus University Hospital Study 2023 -- Assessing the Efficacy and Safety of Romosozumab and Teriparatide in Osteoporotic Postmenopausal Women
