Romosozumab mitigates progression from radiological to symptomatic adjacent-level fractures compared to teriparatide.

UNLABELLED: Romosozumab and teriparatide were compared for preventing symptomatic subsequent vertebral compression fractures (SVCF) after cement augmentation. Across multicenter and hospital-based cohorts, Romosozumab significantly reduced the 2-year incidence and adjusted risk of symptomatic SVCF, particularly adjacent-level fracture, mainly by lowering conversion rate from radiological to symptomatic fractures requiring surgical intervention.

INTRODUCTION

Subsequent vertebral compression fracture (SVCF) was a frequent and severe complication after vertebral cement augmentation, particularly in elderly patients with osteoporosis. This study aimed to compare the effectiveness of romosozumab (RM) and teriparatide (TP) in preventing symptomatic SVCF requiring subsequent operation.

METHODS

This study comprised two cohorts. The first, derived from the Taipei Medical University Clinical Research Database (TMUCRD), included 813 patients who received RM or TP within three months before or after cement augmentation for osteoporotic vertebral compression fracture. Symptomatic SVCF, defined as requiring subsequent vertebral cement augmentation, was compared over a two-year follow-up. The second, a hospital-based cohort of 147 patients from Taipei Medical University Hospital (TMUH), additionally assessed radiographic outcomes.

RESULTS

In the TMUCRD cohort, the RM group showed a significantly lower 2-year incidence of symptomatic SVCF than the TP group (3.61% vs 11.44%, p = 0.003). In the TMUH cohort, symptomatic SVCF occurred particularly at adjacent levels. Although the incidence of radiological adjacent-level SVCF and postoperative analgesic consumption were comparable between groups, RM-treated patients demonstrated lower operation conversion rate (21.1% vs. 59.1%, p = 0.03), indicating that fewer radiological adjacent-level SVCF progressed to symptomatic requiring surgical intervention.

CONCLUSION

RM was associated with a lower incidence of symptomatic adjacent-level SVCF compared to TP. This difference was not attributed to a lower incidence of radiological SVCF, but rather to a reduced conversion rate from radiological to symptomatic fractures requiring surgical intervention.