Romosozumab use before antiresorptive agents tied to greater BMD responder rate in osteoporosis

Romosozumab is a bone-forming agent with the dual effect of increasing bone formation and decreasing bone resorption.

Felicia Cosman et al found in the study that - larger mean bone mineral density (BMD) increases and greater BMD responder rates were achieved when romosozumab was used before, versus after, an antiresorptive agent. Since BMD on treatment is a strong surrogate for bone strength and fracture risk, this analysis supports the thesis that initial treatment with romosozumab followed by an antiresorptive will result in greater efficacy versus the reverse sequence.

To evaluate whether treatment sequence affects romosozumab response, the authors reviewed randomized clinical trials where romosozumab was administered before (ARCH, FRAME) or following (STRUCTURE, Phase 2 extension) an antiresorptive (alendronate or denosumab, respectively).

The authors evaluated changes in total hip (TH) and lumbar spine (LS) BMD, the proportions of patients who achieved BMD gains≥3% and≥6% at the total hip and lumbar spine, and the profile of changes in levels of the bone formation marker procollagen type I N-terminal propeptide (PINP) and the bone resorption marker β-isomer of the C-terminal telopeptide of type I collagen (β-CTX) after 12 and 24 months of treatment with the different treatment sequences.