Age Doesn’t Limit Romosozumab’s Bone Density Benefits, Real-World Study Shows
Belgium: A new prospective observational study published in the January 2026 issue of Bone suggests that age does not influence how well postmenopausal women with osteoporosis respond to romosozumab therapy.
The research, led by Dr. Evelien Gielen from the Geriatrics Department at University Hospitals Leuven, Belgium, provides valuable real-world insights into how older women respond to the anabolic osteoporosis drug.
The study followed 186 postmenopausal women aged between 52 and 96 years who underwent a year of treatment with romosozumab. The median age of participants was 76 years, and more than one-third were aged 80 years or older. Many had recently sustained major osteoporotic fractures, placing them at high risk and making them suitable candidates for anabolic treatment.
Romosozumab, a monoclonal antibody that simultaneously promotes bone formation and inhibits bone breakdown, is approved in both Europe and the United States for postmenopausal women at high risk of fractures. Despite its growing use, evidence on whether bone mineral density (BMD) outcomes differ by age has been limited.
To address this gap, the multinational research team recruited participants from two Belgian centers and one Italian clinic. At baseline, dual-energy x-ray absorptiometry (DEXA) scans showed average T-scores of –2.8 at the lumbar spine, –2.4 at the total hip, and –2.7 at the femoral neck, confirming significant bone loss among the cohort.
After completing the 12-month treatment course, patients demonstrated notable improvements in BMD:
• Lumbar spine BMD increased by 9.2%
• Total hip BMD rose by 3%
A meaningful BMD gain of at least 3% was seen in 80.4% of women at the spine, 51% at the hip, and 46% at the femoral neck.
Importantly, the investigators reported no link between age and BMD response, indicating that even the oldest patients benefited from the therapy. Instead, baseline total hip BMD emerged as an independent predictor of hip BMD improvement, with lower starting values associated with greater gains.
The authors highlighted that the prospective design and multicenter involvement set this study apart from earlier real-world research, enhancing its applicability to everyday clinical practice. However, they acknowledged several limitations: the study focused solely on women who completed the full 12-month regimen, meaning factors such as treatment adherence, side effects, fracture outcomes, and cardiovascular safety were not assessed.
Despite these constraints, the findings reinforce the value of romosozumab for older adults. “Our results may help guide romosozumab use in older women in routine practice,” the authors noted, emphasizing that age alone should not deter clinicians from prescribing anabolic therapy when indicated.
Larger, ongoing multicenter cohort studies are expected to provide further clarity, especially regarding treatment strategies for the “oldest old”—a rapidly growing segment of the population at highest risk for osteoporotic fractures.
Reference:
Gielen, E., Amini, N., Coppens, D., Dejaeger, M., Dupont, J., De Vlam, K., Rossini, M., Viapiana, O., Laurent, M. R., & Adami, G. (2025). Bone mineral density response to romosozumab in post-menopausal women: A prospective observational real-world study. Bone, 202, 117701. https://doi.org/10.1016/j.bone.2025.117701
Next Story