ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026
Romosozumab in older adults: real-world patterns in fracture liaison service cohort.
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, 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
Evidence on romosozumab use in very old adults managed in FLS remains limited. In this descriptive real-world cohort, patients receiving romosozumab had a higher baseline fracture risk phenotype than those receiving antiresorptive therapies, reflecting indication-based prescribing in routine care. Monthly romosozumab showed high 12-month scheduled-treatment completion, whereas completion was lower with daily administered teriparatide. These findings, although exploratory, support the use of romosozumab as a practical option for patients at very high risk. PURPOSE: To describe baseline treatment-allocation profiles and 12-month scheduled-treatment completion among older adults initiating romosozumab and other osteoporosis therapies in routine fracture liaison service (FLS) care and to explore clinical, functional, laboratory, and densitometric trajectories over follow-up.
methodsRetrospective, single-center observational cohort study (Hospital Universitario de Navarra FLS, 2022-2024). Patients at imminent fracture risk (≥ 1 fragility fracture within 24 months before baseline) initiating romosozumab were identified; for each, one patient initiating denosumab, zoledronic acid, and teriparatide was selected by calendar time (same month ± 3 months). Outcomes were assessed at 3 and 12 months. Between-group comparisons used Kruskal-Wallis tests (continuous variables) and Fisher-Freeman-Halton exact tests (categorical variables); when significant, Dwass-Steel-Critchlow-Fligner pairwise tests were performed with Holm-Bonferroni correction. Given the small sample size and non-random treatment allocation, analyses were considered descriptive and hypothesis-generating.
resultsSixty-eight patients were included (n = 17/group). Baseline profiles differed across treatments, consistent with indication-based prescribing; estimated fracture risk (FRAX/QFracture) was higher in anabolic-treated groups. At 12 months, scheduled-treatment completion was 100% among evaluable patients receiving denosumab, romosozumab, and zoledronic acid versus 52.9% with teriparatide; romosozumab versus teriparatide remained significant after Holm adjustment (p = 0.016). Incident fractures and adverse drug reactions were infrequent, and no significant between-group differences were observed in mortality, emergency visits, admissions, falls, fractures, or adverse drug reactions over follow-up. Treatment sequencing at 12 months differed significantly, with heterogeneous post-index regimens after romosozumab and after teriparatide.
conclusionIn this descriptive older adults FLS cohort, romosozumab recipients represented a higher-risk phenotype but showed broadly similar 12-month clinical trajectories compared with other therapies; monthly romosozumab showed high 12-month treatment completion and broadly similar short-term clinical trajectories to other treatment pathways, supporting its use in routine practice. Larger studies are required to determine comparative effectiveness and safety.
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