Comparative Radiologic Outcomes of Romosozumab and Teriparatide in Osteoporotic Vertebral Fractures

Background/Objectives: Osteoporotic vertebral fractures (OVFs) are frequently associated with progressive kyphotic deformity and vertebral height loss, adversely affecting spinal alignment and function. Although romosozumab and teriparatide are established anabolic therapies, comparative data on their longitudinal radiologic effects after OVFs remain limited. This study compared radiologic and clinical outcomes between these agents in patients with OVFs. Methods: Sixty-two patients with single-level OVFs were included: 34 patients in the romosozumab group and 28 patients in the teriparatide group, analyzed in a retrospective, observational comparative study. All patients received anabolic therapy for 6 months followed by sequential denosumab. Radiologic parameters (Cobb angle, vertebral wedge angle, and anterior and middle vertebral body heights) were evaluated at baseline and at 1, 3, 6, and 12 months. Bone mineral density (BMD) and clinical outcomes were assessed at baseline and 12 months. Results: Baseline characteristics were comparable between groups. No statistically significant between-group differences were observed in radiologic parameters over 12 months. However, the romosozumab group showed numerically smaller increases in kyphotic angles and less vertebral height loss, particularly beyond 6 months. Lumbar spine BMD increased in both groups, with a greater absolute gain in the romosozumab group. Back pain improved substantially in both groups, while disability improvement was greater in the teriparatide group. Conclusions: Romosozumab and teriparatide demonstrated comparable radiologic and clinical outcomes in OVFs. Although differences were not statistically significant, romosozumab showed a numerical trend toward better preservation of spinal alignment and vertebral height.