denosumab (RTPR045 / RTPR 045 / DenosteRel)

Real-world comparative effectiveness of denosumab versus zoledronic acid on bone mineral density changes in postmenopausal osteoporosis: An IPTW cohort study.

Li Qinglong Q, Shi Huagang H, Hou Wei W, Gu Tao T et al.

BackgroundTo compare the real-world effectiveness and safety of denosumab versus zoledronic acid in postmenopausal osteoporosis (PMO) and characterize baseline fracture risk profiles.MethodsThis retrospective cohort study included 250 PMO patients treated with denosumab (n = 148) or zoledronic acid (n = 102). Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. The primary endpoint was 12-month change in lumbar spine bone mineral density (BMD). Fracture risk status was descriptively analyzed.ResultsThe cohort was predominantly high-risk (98.4%). IPTW achieved adequate covariate balance. At 12 months, denosumab showed greater increases in lumbar spine BMD than zoledronic acid (6.09% vs. 4.82%; difference 1.27%, 95% CI: 0.474-2.067; P = 0.002), with consistent findings at the hip. Most adverse events were comparable between groups; however, acute phase reaction occurred significantly less frequently with denosumab, while no differences were observed in hypocalcemia or renal events.ConclusionDenosumab was associated with greater BMD gains than zoledronic acid over 12 months, with broadly comparable safety in a real-world PMO population. These findings are limited to short-term BMD outcomes.

Clinical Implications of Denosumab Discontinuation for Spine Surgeons.

Jain Charu C, Drake Matthew T MT, Essig David D, Virk Sohrab S et al.

Genetic Bone Diseases: A Scoping Review of Pathology, Symptoms, Diagnosis, Treatment, and New Horizons.

Jones Colin C, Jayasuriya Ambalangodage C AC

Genetic bone diseases are a rare group of afflictions suffered by the general population. However, their rarity should not diminish research efforts to help patients understand and treat their diseases. This review summarizes the pathology, symptoms, diagnosis, and treatment insight into six well-known genetic bone diseases. Only six bone diseases are included due to the relatively low prevalence of them as whole limiting our scope to ensure accurate information and attention is provided for each disease individually. A literature search of PubMed is conducted, including studies published within the past five years (January 2020-December 2025). Thirty-six studies met inclusion criteria, and no significant risk of bias is identified among the selected articles. Study findings are synthesized into disease overview, clinical and radiographic features, and diagnostic and treatment approaches. Actively developing or novel therapies relevant to each disease are also included. These treatments include: fresolimumab for osteogenesis imperfecta, small interfering ribonucleic acid (RNA) therapy for Osteopetrosis, denosumab for Paget's disease of bone, vosoritide/recifercept/infigratinib for achondroplasia, mesenchymal stem cell therapy for craniosynostosis, and combination losartan and atenolol therapy for Marfan syndrome. These treatments are generally more recently acknowledged in literature and are either actively undergoing research or require further research to determine their efficacy.

Pregnancy- and lactation-associated osteoporosis: A position statement of the IAPM, IOF, ECTS, ESCEO, IMS, and EMAS.

Hadji Peyman P, Athanasiadis Apostolos A, Brandi Maria-Luisa ML, Chakhtoura Marlene M et al.

Pregnancy- and lactation-associated osteoporosis (PLO) is a syndrome characterized by fragility fractures (most commonly vertebral, often multiple) occurring in late pregnancy or the early postpartum period. This position statement summarizes the current knowledge of PLO, and the recommended procedure for assessment, diagnosis and treatment based on a review of published evidence. As PLO is a rare condition, controlled, comparative clinical studies are limited. Individual studies were reviewed, focusing on design, size, follow-up, evaluation of safety, and factors that impact PLO outcomes. Diagnosis of PLO should include a detailed clinical examination, a review of medical and treatment history, and laboratory tests to rule out secondary osteoporosis. Imaging techniques can be used to inform the appropriate treatment pathway, which will depend on whether the patient is antepartum or postpartum. Management of PLO and fractures includes calcium/vitamin D intake/supplementation, considering stopping breastfeeding, and analgesia, if necessary. Treatment with bone-specific agents should be evaluated on an individual basis to reduce subsequent fracture risk, noting that their use in PLO patients is off label. If pharmacological treatments are used, they must be given alongside effective contraceptive measures. Bisphosphonates can pass the placental barrier and are detectable in bone for years, so adverse effects on future pregnancies, although not yet reported, cannot be excluded. Preferred treatment options are teriparatide/abaloparatide or romosozumab. Second-choice treatments are denosumab followed by bisphosphonates or bisphosphonates alone. This position statement includes a pragmatic approach for identifying women with PLO and suggests developing an individualized treatment plan that might include pharmaceutical intervention.