Effectiveness of denosumab, teriparatide and romosozumab for glucocorticoid-induced osteoporosis: a propensity score-matched cohort study.

Abstract

To investigate the effectiveness of denosumab (DMAb), teriparatide (TPTD) and romosozumab (ROMO) in patients with glucocorticoid-induced osteoporosis (GIOP). This multicenter, retrospective cohort study employed propensity score matching to select 42 patients per treatment group [92.1% female, mean age 73.5 years, 35.7% osteoporosis treatment naive, oral glucocorticoids (prednisolone equivalent) 5.4 mg/day, baseline bone mineral density (BMD) T-scores: lumbar spine (LS) -2.5]. Bone turnover markers (BTMs) and BMD were assessed over 12 months. DMAb suppressed BTM levels, whereas TPTD increased them. ROMO showed a dual effect, with increased and decreased levels of formation and resorption markers, respectively. At 12 months, LS BMD increases were greater with ROMO (9.5%) and tended to be higher with TPTD (8.4%) compared with DMAb (4.4%) (P = 0.008 for ROMO vs DMAb). At 6 months, total hip BMD increased with DMAb (2.6%) and ROMO (1.8%) but decreased with TPTD (-0.6%; P = 0.01 for DMAb vs TPTD; P = 0.042 for ROMO vs TPTD); no significant differences were observed at 12 months (3.2%, 2.6%, 2.2%, respectively). DMAb showed significant increases in femoral neck BMD at 6 (2.2%) and 12 (3.0%) months from baseline. BTM levels reflected expected pharmacological actions of each drug. ROMO showed greater LS BMD gains than DMAb, while TPTD demonstrated a similar response, whereas DMAb may provide earlier benefits at cortical-rich sites. These findings underscore the importance of site-specific, individualized treatment strategies for GIOP.