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Review
. 2025 Jan;43(1):3-9.
doi: 10.1007/s00774-024-01536-0. Epub 2024 Jul 15.

Clinical effects of teriparatide, abaloparatide, and romosozumab in postmenopausal osteoporosis

Kosuke Ebina  1   2 , Yuki Etani  3 , Takaaki Noguchi  4 , Ken Nakata  5 , Seiji Okada  4
Affiliations
Review

Clinical effects of teriparatide, abaloparatide, and romosozumab in postmenopausal osteoporosis

Kosuke Ebina et al. J Bone Miner Metab. 2025 Jan.

Abstract

In the management of osteoporosis, anti-resorptive agents serve as a primary therapeutic approach. However, in cases where individuals exhibit an increased susceptibility to fractures, such as those characterized by severe low bone mass or a history of vertebral or hip fractures that markedly diminish life expectancy, the immediate reduction of fracture risk through the administration of osteoanabolic agents could be beneficial. Teriparatide, available in daily, once-weekly, or twice-weekly dosages, along with abaloparatide and romosozumab, constitutes a trio of such agents. Each of these medications is defined by unique characteristics, distinct efficacy profiles, and specific adverse effects. There is growing evidence to suggest that these agents have a superior effect on enhancing bone mineral density and reducing fracture incidence when compared to traditional bisphosphonate therapies. Nonetheless, their employment demands thorough consideration of clinical indications, which includes evaluating economic factors, the frequency of injections required, and the potential for adverse effects. The objective of this review is to consolidate the current evidence focusing primarily on the efficacy of these agents, with the goal of enhancing understanding and aiding in making more informed treatment decisions, particularly for those individuals who are at an elevated risk of fractures.

Keywords: Abaloparatide; Osteoanabolic agent; Postmenopausal osteoporosis; Romosozumab; Teriparatide.

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Conflict of interest statement

Declarations. Conflict of interest: KE and YE are affiliated with the Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, which is supported by Asahi-Kasei. KE has received research grants from Asahi-Kasei, Eisai, Ono, and Teijin Pharma. KE has received lecture fee from Amgen, Asahi-Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, Ono, Pfizer, Taisho, and Teijin Pharma. KE has received consultant fee from Asahi-Kasei, Taisho, and Teijin Pharma. YE has received a research grant from Eli Lilly. KN has received a research grant from Astellas and supervises the Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, which is supported by Asahi-Kasei. TN and SO declare that they have no conflicts of interest. Ethical approval: Since this manuscript is a review article, it is not subject to the ethical standards of the institutional and/or national research committees or to the 1964 Helsinki Declaration and its subsequent amendments or comparable ethical standards.

Figures

Fig. 1
Fig. 1
Incidence of a vertebral and b non-vertebral fractures in treatment versus placebo groups in pivotal trials of osteoanabolic agents among women with postmenopausal osteoporosis. Bar heights indicate the fracture incidence in both placebo and treatment groups. Each treatment group's relative risk reduction, with corresponding P value, is provided. Additionally, the studies' names, countries of the patient populations, and names of the agents are detailed. Note: Due to variations in patient populations and follow-up durations across the studies, comparisons between studies are not recommended. TPTD teriparatide, ABL abaloparatide, ROMO romosozumab. PFT pivotal fracture trial [14]; ACTIVE Abaloparatide Comparator Trial in Vertebral Endpoints Trial [17], ACTIVE-J [18]; TOWER teriparatide once-weekly efficacy research [11], FRAME Fracture Study in Postmenopausal Women with Osteoporosis study [21], FRAME Japanese [EVENITY (Common Technical Document, M2.7.3). Tokyo, Japan: Amgen KK, Inc.; 2019]. RRR relative risk reduction. *RRR not provided
See this image and copyright information in PMC

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