Romosozumab Enhances Vertebral Bone Structure in Women With Low Bone Density.


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Authors
Treece, Graham M 
Pearson, Rose A 
Gee, Andrew H 
Bolognese, Michael A  ORCID logo  https://orcid.org/0000-0002-7102-5518
Abstract

Romosozumab monoclonal antibody treatment works by binding sclerostin and causing rapid stimulation of bone formation while decreasing bone resorption. The location and local magnitude of vertebral bone accrual by romosozumab and how it compares to teriparatide remains to be investigated. Here we analyzed the data from a study collecting lumbar computed tomography (CT) spine scans at enrollment and 12 months post-treatment with romosozumab (210 mg sc monthly, n = 17), open-label daily teriparatide (20 μg sc, n = 19), or placebo (sc monthly, n = 20). For each of the 56 women, cortical thickness (Ct.Th), endocortical thickness (Ec.Th), cortical bone mineral density (Ct.bone mineral density (BMD)), cancellous BMD (Cn.BMD), and cortical mass surface density (CMSD) were measured across the first lumbar vertebral surface. In addition, color maps of the changes in the lumbar vertebrae structure were statistically analyzed and then visualized on the bone surface. At 12 months, romosozumab improved all parameters significantly over placebo and resulted in a mean vertebral Ct.Th increase of 10.3% versus 4.3% for teriparatide, an Ec.Th increase of 137.6% versus 47.5% for teriparatide, a Ct.BMD increase of 2.1% versus a -0.1% decrease for teriparatide, and a CMSD increase of 12.4% versus 3.8% for teriparatide. For all these measurements, the differences between romosozumab and teriparatide were statistically significant (p < 0.05). There was no significant difference between the romosozumab-associated Cn.BMD gains of 22.2% versus 18.1% for teriparatide, but both were significantly greater compared with the change in the placebo group (-4.6%, p < 0.05). Cortical maps showed the topographical locations of the increase in bone in fracture-prone areas of the vertebral shell, walls, and endplates. This study confirms widespread vertebral bone accrual with romosozumab or teriparatide treatment and provides new insights into how the rapid prevention of vertebral fractures is achieved in women with osteoporosis using these anabolic agents. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Description

Funder: NIHR Cambridge BRC; Id: http://dx.doi.org/10.13039/501100018956

Keywords
ANABOLICS, ANALYSIS/QUANTITATION OF BONE, ANTIRESORPTIVES, BONE QCT/microCT, DISEASES AND DISORDERS OF/RELATED TO BONE, OSTEOPOROSIS, THERAPEUTICS, Antibodies, Monoclonal, Bone Density, Bone Density Conservation Agents, Female, Humans, Lumbar Vertebrae, Osteoporosis, Osteoporosis, Postmenopausal, Teriparatide
Journal Title
J Bone Miner Res
Conference Name
Journal ISSN
0884-0431
1523-4681
Volume Title
Publisher
Oxford University Press (OUP)
Sponsorship
Amgen (RG72842)
This research was funded by Amgen and supported by the NIHR Cambridge BRC. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.