gms | German Medical Science

Objectives: This research was undertaken to ascertain the relative clinical efficacy of denosumab, romosozumab, and teriparatide, vis-à-vis bisphosphonates, in the treatment of osteoporosis, a domain where comprehensive comparative studies are scant. Specifically, the study aimed to delineate the impact of these non-bisphosphonate therapeutic agents on bone mineral density and vertebral morphological alterations in patients afflicted with Osteoporotic Vertebral Compression Fractures (OVCF). Such evaluation is pivotal in guiding therapeutic decision-making in osteoporotic care.

Methods: The cohort comprised patients diagnosed with OVCF from January 1, 2016, to June 30, 2023, who were administered either denosumab, romosozumab, or teriparatide. To assess the clinical effectiveness of these treatments, a matched-pair analysis was conducted, aligning participants based on gender, age, and baseline bone mineral density (BMD). Each treatment group included 25 patients, totaling 75, who underwent dual-energy X-ray absorptiometry (DXA) and lateral spine radiography pre-treatment and at the one-year follow-up. The primary endpoints were changes in bone density, assessed via DXA, and vertebral body kyphotic alterations, evaluated through radiographic measurements.

Results and conclusion: All three medications demonstrated an increase in lumbar spine BMD, with romosozumab and teriparatide exhibiting significantly enhanced efficacy compared to denosumab (p=0.033 and p=0.001, respectively). Romosozumab and denosumab significantly suppressed kyphotic deformation, as quantified by Cobb angle compared to teriparatide (p=0.002 and p=0.004, respectively). The findings suggest that while all three medications are effective in managing OVCF, romosozumab and teriparatide have a more pronounced impact on bone density improvement, and romosozumab and denosumab are more efficacious in mitigating vertebral kyphotic deformation. Considering the combined outcomes for BMD and Cobb angle, romosozumab emerges as a potentially more effective option in the OVCF treatment arsenal among the studied non-bisphosphonate drugs.