Longitudinal Effects of Denosumab, Romosozumab, and Combination Therapy on Muscle Quality and Metabolic Profiles a Randomized Controlled Trial

Presenter: H.K. Yen

This randomized study evaluated denosumab, romosozumab, and combination therapy in 114 osteoporotic patients over six months. Participants were equally assigned to denosumab, romosozumab, or combined treatment. Outcomes Included evaluation ofhandgrip strength, skeletal muscle mass, body mass index (BMI), fat mass, and glycated Hemoglobin level (HbA1c).

Baseline characteristics were comparable across groups (p>0.05), and no significant time‑by‑group interactions were observed. At six months, handgrip strength improved with denosumab (+4.9%), romosozumab (+3.1%), and combination therapy (+4.0%) (p<0.05), and skeletal muscle mass increased by 1.6%, 1.0%, and 1.1%, respectively (p<0.05). HbA1c decreased only with denosumab (−2.8%, p=0.015).

In conclusion, all treatments equally enhanced muscle strength and mass, while denosumab alone provided additional glycemic benefit.

Denosumab Use in Advanced CKD Patients: Yes or No? This is the Dilemma

Presenter: M. Fusaro

This overview summarizes clinical evidence on the use of denosumab in osteoporosis patients with impaired renal function. Denosumab, a monoclonal antibody, inhibits receptor activator of nuclear factor kappa‑B ligand (RANKL) and is not renally cleared, eliminating the need for dose adjustment. Post‑hoc analysis of the FREEDOM trial, including women with creatinine clearance (CrCl) 15–59 mL/min, showed comparable safety and significant spine and hip bone mineral density (BMD) gains, with a 68% reduction in vertebral fracture odds in moderate renal impairment. A retrospective study in dialysis‑dependent chronic kidney disease patients demonstrated marked improvements in bone density and strength up to 3.5 years, followed by plateauing. Hypocalcemia remained the principal risk, emphasizing the need for long‑term treatment planning and careful calcium and vitamin D management.

Combining Teriparatide to Established Denosumab Therapy: Impact on Bone Mineral Density in A Clinical Case Series

Presenter: A. Carroll

This retrospective case series examined the effects of adding teriparatide to long‑term denosumab therapy in patients with severe osteoporosis.

Nine patients (median age 72 years), treated with denosumab for a median of 7.2 years, received teriparatide for 18–24 months. Lumbar spine bone mineral density (BMD) increased significantly in all patients (median +9.2%), while changes in total hip BMD were inconsistent and not significant. CTX levels rose transiently at 6 months before declining, suggesting increased bone remodelling.

BMD response was independent of prior denosumab duration or baseline CTX. Findings align with limited previous data and support further study of this combination approach.

Large Increase in Hip and Spine BMD After Combination Therapy with Denosumab and Teriparatide: Real World Experience

Presenter: F. Brennan

This retrospective study assessed the real‑world effectiveness of concurrent teriparatide and denosumab therapy in patients with severe osteoporosis.

Thirteen patients (mean age 79 years) completed two years of combination treatment. Significant gains in bone mineral density were observed, with an 18.0% increase at the lumbar spine and a 9.3% increase at the total hip. Changes in bone turnover markers suggested reduced resorption and increased formation, though these were not statistically significant, likely due to small sample size.

Despite limitations, including variable timing of baseline DXA, results support the clinical effectiveness of combination therapy and compare favourably with teriparatide alone.

Differential Effects of Osteoporosis Therapies on Trabecular Bone Score: A Systematic Review and Meta-Analysis

Presenter: E. Shevroja

This systematic review and meta-analysis evaluated how different osteoporosis therapies affect trabecular bone score (TBS), a DXA-derived measure of bone microarchitecture that complements bone mineral density (BMD).

Sixty studies (17 RCTs, 43 non-randomised) were included. Bisphosphonates produced minimal, non‑significant TBS changes, while denosumab led to modest but significant increases over time. Anabolic agents had larger effects: teriparatide significantly improved TBS at 24 months, and romosozumab produced the greatest gains at 12 months, outperforming alendronate and denosumab.

Overall, treatments showed distinct, mechanism-based effects on TBS, supporting its use alongside BMD to assess therapy response and guide treatment selection in osteoporosis management.

Realworld Prescribing Patterns of Combination Therapy with Denosumab and Teriparatide (COMBIDATA) Among Indian Orthopaedicians: A Cross-sectional Survey

Presenter: S. Londhe

The COMBIDATA survey evaluated real‑world use of denosumab–teriparatide combination therapy among Indian Orthopaedicians managing severe osteoporosis.

Sixty‑six respondents completed a questionnaire. Most clinicians (92.4%) had prescribed the combination, typically for 1–25% of patients in their practice, mainly those with severe osteoporosis and vertebral or hip fractures, especially aged 61–70 years. Denosumab was commonly initiated alongside or within three months of teriparatide, with DXA monitoring usually at 12 months. Musculoskeletal pain and cramps were the most reported adverse effects, while osteonecrosis of the jaw was rare.

Cost, injection burden, and severe renal impairment were major barriers, highlighting the need for improved education and guidance to optimise therapy use.

Medication-Related Osteonecrosis of the Jaw and Atypical Femur Fractures Associated with Antiresorptive Therapy in Osteoporosis: A 10-Year Retrospective Analysis

Presenter: B. Fernandes Esteves

This retrospective study describes medication‑related osteonecrosis of the jaw (MRONJ) and atypical femur fractures (AFF) associated with antiresorptive therapy over 10 years at a tertiary rheumatology centre.

Thirteen female patients (mean age 72 years) were identified: nine with MRONJ and four with AFF. AFF was associated with significantly longer osteoporosis duration and prolonged antiresorptive exposure, occurring exclusively with alendronate. MRONJ occurred with both bisphosphonates and denosumab, with denosumab-related cases arising after shorter exposure. Antiresorptives were discontinued in all cases.

Subsequent osteoporosis management was challenging; teriparatide was most commonly used after bisphosphonate-related events, while optimal post‑event sequencing remains undefined.

WCO-IOF-ESCEO Congress, April 16-19, 2026, Prague, Czech Republic