ArticleTherapeutic advances in musculoskeletal disease2026
Cardiovascular safety of romosozumab versus denosumab for osteoporosis treatment: a multinational real-world data analysis.
Article in Therapeutic advances in musculoskeletal disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Romosozumab and denosumab are two highly effective, widely used osteoporosis treatments. There has been no study directly comparing the effectiveness of romosozumab and denosumab in a clinical setting using large-scale, real-world data. Objectives: To evaluate the association between romosozumab and cardiovascular outcomes compared to denosumab in patients with osteoporosis. Design: Retrospective propensity score-matched cohort study. Methods: Using the TriNetX global health research network, we identified 59,058 patients aged 60 years or older with osteoporosis who initiated romosozumab ( Results: Among patients without a prior cardiovascular history, romosozumab was associated with significantly lower risks of 3P-MACE at 3-year (hazard ratio (HR) 0.645, 95% confidence interval (CI) 0.438-0.950, Conclusion: Romosozumab was associated with lower risks of 3P-MACE and mortality compared to denosumab among patients without a prior cardiovascular history at mid-term and long-term follow-up. In contrast, romosozumab was associated with consistently higher cardiovascular risks in patients with preexisting CVD. These findings highlight the importance of careful cardiovascular risk assessment prior to initiating romosozumab, particularly in patients with preexisting CVD. The 3P-MACE finding in patients without prior cardiovascular history is the primary confirmatory result; all other outcomes should be considered exploratory and hypothesis-generating.
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