What type of study is this?

This is a Retrospective cohort study study.

September 10, 2025Open Access

Impact of baseline PINP on the BMD increase with romosozumab, teriparatide, and denosumab in treatment-naïve primary osteoporosis: A retrospective cohort study

YEYuki EtaniThe University of Osaka TNTakaaki NoguchiThe University of Osaka TYToshitaka YukishimaHamamatsu University

Key Points

Patients with higher baseline PINP levels experience greater BMD increases with romosozumab compared to teriparatide.
Increases in lumbar spine BMD were similar between romosozumab and teriparatide in low PINP groups.
Romosozumab showed robust increases in total hip and lumbar spine BMD across all baseline PINP levels.
Both teriparatide and denosumab showed increases in BMD comparable to romosozumab in certain PINP groups.

Abstract

To investigate the impact of baseline total N-terminal propeptide of procollagen (PINP) levels on increases in bone mineral density (BMD) after treatment with romosozumab (ROMO), teriparatide (TPTD), and denosumab (DMAb) in patients with treatment naïve primary osteoporosis. This multicenter, retrospective cohort study included 462 treatment-naïve patients (88.7 % female; mean age, 75.5 years; baseline BMD T-scores: lumbar spine LS, -3.0; total hip TH, -2.7) who initiated treatment with ROMO (n = 310), TPTD (n = 70), or DMAb (n = 82). Patients were stratified by baseline total PINP levels into low (≤ 70.1 μg/L) and high (> 70.1 μg/L) groups. After adjusting for baseline characteristics using inverse probability of treatment weighting, changes in BMD were evaluated at 12 months. In the low PINP group, increases in LS BMD were similar between ROMO and TPTD; in the high PINP group, ROMO led to greater increases in LS BMD than TPTD. ROMO resulted in greater increases in TH BMD than TPTD, regardless of PINP level. Compared with DMAb, ROMO resulted in greater increases in LS BMD and TH BMD in the low PINP group, whereas no significant differences were observed in the high PINP group. ROMO demonstrated robust increases in both LS and TH BMD across all PINP levels. TPTD led to increases in LS BMD comparable to those with ROMO in the low PINP group. DMAb led to increases in both LS and TH BMD comparable to those with ROMO in the high PINP group.

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