Efficacy of romosozumab as sequential therapy for bisphosphonates in glucocorticoid-induced osteoporosis

Glucocorticoids (GCs) affect the Wnt signaling pathway, which is a key mechanism underlying GC-induced osteoporosis (GIOP). The efficacy of romosozumab (ROMO), an antibody targeting sclerostin-an inhibitor of Wnt signaling-in treating GIOP remains unclear, as does its effectiveness when used sequentially after bisphosphonates (BP). In this prospective observational study, we aimed to evaluate the efficacy of ROMO as a sequential therapy following BP in patients with GIOP. Patients with rheumatic diseases receiving BP and GCs equivalent to 5 mg/d or more of prednisolone for at least 6 mo were enrolled and either switched from BP to ROMO (ROMO group) or continued on BP (BP group). BMD of the LS (L2-4), FN, and TH were measured every 6 mo, and bone turnover markers were assessed every 3 mo. Six patients in the ROMO group and 22 in the BP group were analyzed. Patients in the ROMO group were significantly older (78.5 vs 64.5 yr), had a higher history of vertebral fractures, had lower baseline BMD of the FN and TH, and tended to receive higher GC dose (8.0 mg vs 5.0 mg) compared with the BP group. The median (25th-75th percentile) BMD percent changes at 12 mo were numerically higher in the ROMO group compared to the BP group (LS 2.6 [0.8-3.4] % vs 1.6 [-1.9-4.3] %; FN 1.4 [-0.5-5.4] % vs 1.0 [-4.7-5.6] %; TH: 1.1 [-7.6-6.5] % vs -1.8 [-6.4-1.8] %), although their differences were not statistically significant. One new vertebral fracture was observed in the BP group, and 1 patient in the ROMO group experienced a cerebral infarction. These findings suggest that ROMO may be an effective sequential therapy for BP in patients with GIOP.