Drugs Compared for Improving Lumbar Spine Bone Density in Glucocorticoid-Induced Osteoporosis

 In patients with glucocorticoid-induced osteoporosis, lumbar spine bone mineral density (BMD) increased more in those on romosozumab or teriparatide than in those on denosumab at 12 months. Levels of bone turnover markers varied by therapy at 12 months, with reduced levels in the denosumab group and increased levels in the teriparatide group.

METHODOLOGY:

• Researchers conducted a multicenter, retrospective comparative cohort study using data from the Osteoporosis Aging Surveillance and Interventions project in Japan to evaluate the effects of various treatments in patients with glucocorticoid-induced osteoporosis.
• They included patients who were treatment-naive or had an inadequate response to previous bisphosphonate therapy. Patients initiated denosumab, teriparatide, or romosozumab, with previous bisphosphonates stopped before starting the study drugs. Criteria for high fracture risk in the participants guided the selection of teriparatide or romosozumab.
• Propensity score matching without replacement was employed, yielding 42 patients in each group: denosumab (mean age, 75.9 years; 85.7% female individuals), teriparatide (mean age, 72.6 years; 95.2% female individuals), and romosozumab (mean age, 72.1 years; 92.9% female individuals).

TAKEAWAY:

• Lumbar spine BMD on DEXA showed greater mean percentage change in the romosozumab vs denosumab group at 6 months (6.4% vs 3.9%; P = .049) and 12 months (primary endpoint: 9.5% vs 4.4%; P = .008). The teriparatide group exhibited increases in BMD that were similar to those observed in the romosozumab group at both 6 and 12 months.
• At 6 months, total hip mean BMD change was lower in the teriparatide group than in the denosumab (P = .01) and romosozumab (P = .042) groups; no between ‑ group differences were detected at 12 months. Only the denosumab group showed significant increases in femoral neck BMD from baseline to 6 months (P = .008) and 12 months (P = .01), with no significant between ‑ group differences at 12 months.
• Levels of bone turnover markers differed by therapy at 12 months; levels of procollagen N-terminal type 1 propeptide (P = .003) and tartrate-resistant acid phosphatase isoform 5b (TRACP-5b; P < .001) were reduced from baseline in the denosumab group, whereas the levels of these markers increased in the teriparatide group (P < .001 for both). The romosozumab group showed a decrease in TRACP ‑ 5b levels from baseline (P < .001).
• A negative association was noted between lumbar spine BMD and baseline lumbar spine T ‑ scores (standardized regression coefficient, -0.34; P < .001) and between total hip BMD and baseline total hip T ‑ scores (standardized regression coefficient, -0.36; P < .001). Overall, no between-group differences were observed in the incidence of fractures.

IN PRACTICE:

“[The study] findings showed that the patterns of changes in [bone turnover marker] levels and BMD differed based on the distinct mechanisms of action of each drug,” the authors of the study wrote. “[The] findings suggest that site-specific BMD responses may be relevant when considering individualized treatment strategies in patients with [glucocorticoid-induced osteoporosis],” they added.

SOURCE:

This study was led by Toshitaka Yukishima, Hamamatsu University School of Medicine in Hamamatsu, Japan. It was published online on February 12, 2026, in Rheumatology.

LIMITATIONS: 

Underlying glucocorticoid ‑ treated conditions varied, and disease activity was not comprehensively assessed. Data on smoking and alcohol use were unavailable, and cumulative glucocorticoid exposure could not be assessed. Two DEXA systems were used without cross ‑ calibration, thereby introducing device variability. Prior bisphosphonate duration and washout were inconsistently recorded.

DISCLOSURES:

The work was supported by a grant from the Japanese Osteoporosis Society. Some authors reported having financial relationships with Amgen, which markets denosumab and romosozumab, and Eli Lilly, which markets teriparatide.

https://www.medscape.com/viewarticle/drugs-compared-improving-lumbar-spine-bone-density-2026a10007ub