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TOPLINE:

Romosozumab use in adults with osteoporosis was associated with a 21% reduction in risk for osteoarthritis, particularly knee osteoarthritis, compared with teriparatide use.

METHODOLOGY:

• Researchers used a new-user cohort design to emulate a target trial, comparing the risk for incident osteoarthritis between the use of romosozumab and teriparatide in individuals with osteoporosis, using a nationwide administrative claims database.
• They identified 8504 new users of romosozumab (210 mg administered once monthly) and 13,641 new users of teriparatide (administered in various dosing regimens), all free of known osteoarthritis at baseline, from April 2014 to November 2022.
• Inverse probability of treatment weighting and inverse probability of censoring weighting were applied to estimate treatment effect and account for informative censoring, respectively, and baseline characteristics were balanced between groups.
• The primary outcome was the new occurrence of osteoarthritis, with secondary outcomes including joint-specific osteoarthritis.
• Individuals with osteoporosis (mean age, 79.9 years; 86.6% women) in the romosozumab and teriparatide groups were followed up for mean durations of 233 days and 209 days, respectively.

TAKEAWAY:

• Individuals using romosozumab had a 21% lower risk for incident osteoarthritis than those using teriparatide (relative risk [RR], 0.79; 95% CI, 0.66-0.89), with an absolute risk reduction of 1.1%.
• The risk for knee osteoarthritis was significantly lower in the romosozumab group than in the teriparatide group (RR, 0.79; 95% CI, 0.66-0.92), with an absolute risk reduction of 0.8%.
• No significant differences were observed for hip and hand osteoarthritis, although trends favored romosozumab.
• In a 2-year follow-up, individuals using romosozumab had a lower risk for osteoarthritis than those using oral bisphosphonates, with an absolute risk reduction of 2.6% (RR, 0.74; 95% CI, 0.61-0.86).

IN PRACTICE:

“These findings suggest that romosozumab is a promising therapeutic option for addressing osteoporosis and preclinical osteoarthritis related to osteoporosis, potentially offering dual skeletal benefits in high-risk populations,” the authors of the study wrote.

SOURCE:

The study was led by Masaki Hatano, MD, School of Public Health, The University of Tokyo, Tokyo, Japan. It was published online on July 11, 2025, in Annals of the Rheumatic Diseases.

LIMITATIONS:

The short follow-up period may not fully capture the incidence of osteoarthritis, as romosozumab is approved for use for only 12 months. The lack of detailed clinical data, such as dual x-ray absorptiometry and bone biomarkers, limited the ability to assess osteoporosis severity. Residual confounding factors such as patient or physician preferences could have influenced treatment choices, thereby affecting the findings.

DISCLOSURES:

This study was supported by a grant from the Ministry of Health, Labour and Welfare, Japan. One author disclosed receiving financial support from DeSC Healthcare, Inc., for the current study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.