In a comparative analysis of three leading osteoporosis therapies, Duke researcher and spine surgeon Koji Ishikawa, MD, PhD, and biomechanical expert Tony M. Keaveny, PhD, report that romosozumab yields significantly greater improvements in bone strength at the hip and spine than teriparatide or denosumab. Using advanced finite element modeling and virtual stress testing, the study revealed that romosozumab increased vertebral bone strength by approximately 40%—a gain that far exceeds the 25% increase in bone mineral density (BMD) measured by DXA.
These findings underscore the clinical importance of evaluating biomechanical integrity rather than relying solely on BMD metrics. Romosozumab’s dual anabolic and antiresorptive action appears to remodel severely osteoporotic vertebrae into structurally resilient bone uniquely, reducing biomechanical failure risk more effectively than other agents.
For clinicians managing high-risk osteoporosis patients, especially those with prior vertebral fractures or poor DXA response, romosozumab may offer a superior therapeutic pathway to fracture prevention and functional recovery.
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