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

Purpose 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-naive patients initiating Romo, TPTD, or DMAb (Study 1) and patients switching from one anabolic therapy to another (Study 2). Methods 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). Results 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. Conclusion In this real-world BCT study, Romo showed greater increases in both vertebral bone strength and density versus TPTD and DMAb in treatment-naive 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.