ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2022
Romosozumab and antiresorptive treatment: the importance of treatment sequence.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
66 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Efficacy and safety of sequential therapy for primary osteoporosis with bone formation promoters followed by bone resorption inhibitors: a meta-analysis.Journal of orthopaedic surgery and research · 2025Pooled it
- Romosozumab adverse event profile: a pharmacovigilance analysis based on the FDA Adverse Event Reporting System (FAERS) from 2019 to 2023.Aging clinical and experimental research · 2025Pooled it
- [Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024) : Guidelines of the Austrian Society for Bone and Mineral Research].Wiener klinische Wochenschrift · 2024Guideline
- Romosozumab followed by denosumab versus denosumab only: a post hoc analysis of FRAME and FRAME extension.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2024Trial
- Efficacy of denosumab on bisphosphonate-treated osteoporosis and osteopenia in systemic rheumatic disease patients receiving glucocorticoids.Journal of bone and mineral metabolism · 2023Trial
- Imminent fracture risk: contributing mechanisms, risk assessment, and implications for treatment.The Journal of clinical endocrinology and metabolism · 2026Review
- [Osteoporosis in rheumatology-Diagnostics, risk assessment and modern treatment strategies].Zeitschrift fur Rheumatologie · 2026Article
- Article
- Efficacy of sequential romosozumab-denosumab therapy in patients on hemodialysis: association with bone mineral density improvement and TRACP-5b rebound.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Effects of romosozumab on the peripheral and axial skeleton in postmenopausal women at high fracture risk: real-world evidence from DXA and HR-pQCT data.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Early bone-formation response to sclerostin antibody is altered by prior antiresorptive treatment in ovariectomized rats.JBMR plus · 2026Article
- Impact of Prior Treatment and Predictive Factors in Sequential Romosozumab-Denosumab Therapy for Severe Osteoporosis.Yonsei medical journal · 2026Observational
- Mechanisms underlying the waning of osteoanabolic therapy effects in osteoporosis.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2026Review
- Densitometric gains do not uniformly translate into clinical and psychosocial recovery: a 12-month multidimensional analysis of romosozumab therapy in postmenopausal osteoporosis.BMC musculoskeletal disorders · 2026Article
- Osteoporosis medication exposure patterns and MRONJ occurrence in patients receiving romosozumab: a retrospective observational study.Clinical oral investigations · 2026Observational
- Romosozumab and Denosumab Combination Therapy After Denosumab in Postmenopausal Osteoporosis.Arthritis & rheumatology (Hoboken, N.J.) · 2026Article
- Efficacy of combination and sequential therapy with romosozumab.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Romosozumab super-responders in clinical practice: insights from a large Italian multicenter cohort of women with severe postmenopausal osteoporosis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- A Commentary on "Romosozumab Enhances Implant Stability in Glucocorticoid-Induced Osteoporotic Bone: A Rabbit Model Study".Neurospine · 2026Article
- Article
6 more citing papers are in PubMed but not listed here.
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
To evaluate whether treatment sequence affects romosozumab response, this analysis reviewed studies where romosozumab was administered before or following an antiresorptive (alendronate or denosumab). Initial treatment with romosozumab followed by an antiresorptive resulted in larger increases in bone mineral density of both hip and spine compared with the reverse sequence.
introductionTeriparatide followed by an antiresorptive increases bone mineral density (BMD) more than using an antiresorptive first. To evaluate whether treatment sequence affects romosozumab response, we reviewed randomized clinical trials where romosozumab was administered before (ARCH, FRAME) or following (STRUCTURE, Phase 2 extension) an antiresorptive (alendronate or denosumab, respectively).
methodsWe evaluated BMD percentage change for total hip (TH) and lumbar spine (LS) and response rates (BMD gains ≥ 3% and ≥ 6%) at years 1 and 2 (except STRUCTURE with only 1-year data available).
resultsWith 1-year romosozumab initial therapy in ARCH and FRAME, TH BMD increased 6.2% and 6.0%, and LS BMD increased 13.7% and 13.1%, respectively. When romosozumab was administered for 1 year after alendronate (STRUCTURE) or denosumab (Phase 2 extension), TH BMD increased 2.9% and 0.9%, respectively, and LS BMD increased 9.8% and 5.3%, respectively. Over 2 years, TH and LS BMD increased 7.1% and 15.2% with romosozumab/alendronate, 8.5% and 16.6% with romosozumab/denosumab, and 3.8% and 11.5% with denosumab/romosozumab, respectively. A greater proportion of patients achieved BMD gains ≥ 6% when romosozumab was used first, particularly for TH, versus the reverse sequence (69% after romosozumab/denosumab; 15% after denosumab/romosozumab).
conclusionIn this study, larger mean 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.
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