Effect of the duration of previous osteoporosis treatment on the effect of romosozumab treatment

Osteoporos Int. 2022 Jun;33(6):1265-1273. doi: 10.1007/s00198-021-06261-2. Epub 2022 Jan 21.


The effect of romosozumab is affected by previous osteoporosis treatment. Here we showed that the duration of the previous treatment just before romosozumab affects the therapeutic effect of romosozumab. Using denosumab and oral bisphosphonates for more than 1 year attenuates the effect of romosozumab.

Introduction: As an anti-sclerostin antibody, romosozumab suppresses bone resorption and stimulates bone formation. We investigated whether the effectiveness of 12 months of romosozumab treatment depended on the duration of previous treatment with teriparatide, denosumab, or oral bisphosphonates.

Methods: In total, 259 osteoporosis patients received subcutaneous injections of romosozumab (210 mg) every 4 weeks during 2019 and 2020. This study was designed as a pre-post comparison. The end points were the percent changes of bone mineral density (BMD) after 12 months of romosozumab treatment. The patients were divided into seven groups depending on the type and duration of previous treatment before starting romosozumab as follows: non-previous treatment group, change from teriparatide used for 1 year or less/more than 1 year, change from denosumab used for 1 year or less/more than 1 year, and change from oral bisphosphonates used for 1 year or less/more than 1 year.

Results: The effects of previous treatment with teriparatide on the effectiveness of 12-month romosozumab did not clearly depend on the duration of treatment (p > 0.05). In contrast, the effects of previous treatments with denosumab or oral bisphosphonates on the effectiveness of 12-month romosozumab depended on the previous treatment duration, which was reflected by the differences in percent change of the spine BMD (both p < 0.05), however, there were no significant differences in the percent change of the total hip BMD (both p > 0.05).

Conclusion: The duration of the previous treatment affected the effectiveness of romosozumab. Using denosumab and oral bisphosphonate for more than 1 year attenuated the effect of romosozumab.

Keywords: Anti-osteoporosis drug; Anti-sclerostin antibody; BMD; Duration of previous treatment; Osteoporosis; Romosozumab.

MeSH terms

  • Antibodies, Monoclonal
  • Bone Density
  • Bone Density Conservation Agents* / pharmacology
  • Bone Density Conservation Agents* / therapeutic use
  • Denosumab / pharmacology
  • Denosumab / therapeutic use
  • Diphosphonates / therapeutic use
  • Female
  • Humans
  • Osteoporosis* / chemically induced
  • Osteoporosis* / drug therapy
  • Osteoporosis, Postmenopausal* / chemically induced
  • Osteoporosis, Postmenopausal* / drug therapy
  • Teriparatide / pharmacology
  • Teriparatide / therapeutic use


  • Antibodies, Monoclonal
  • Bone Density Conservation Agents
  • Diphosphonates
  • Teriparatide
  • romosozumab
  • Denosumab