Work

Association of baseline glycaemic status with BMD change after 12 doses of romosozumab: a retrospective cohort study of 170 patients

Year: 2026

Type: article

Abstract: Objective: We evaluated whether dysglycaemia is an independent factor associated with bone mineral density (BMD) gain during romosozumab treatment. Methods: We included all patients who initiated and received 12 doses of romosozumab in two Osteoporosis Centres from January 2019 to March 2025 and had dual-energy X-ray absorptiometry performed at baseline and upon completion of romosozumab. The cohort was divided into three groups. Diabetes was defined by physician diagnosis, glycated haemoglobin (HbA1c) ≥ 6.5%, or anti-diabetic medication use. Among those without known diabetes, HbA1c 5.7%-6.4% defined prediabetes and HbA1c ≤ 5.6% defined normoglycaemia. Percentage of BMD (%BMD) gain while on romosozumab was calculated. Multivariable linear regression analysis was used to identify independent factors associated with %BMD gain. Results: ): 59.4% had normoglycaemia, 25.9% prediabetes, and 14.7% diabetes (all type 2). Of these, 64.1% had prior antiresorptive exposure. Baseline mean BMD T-scores (95% CI) were -3.0 (-3.2, -2.9) (lumbar spine, LS), -2.9 (-3.1, -2.8) (femoral neck, FN), and -2.6 (-2.7, -2.4) (total hip, TH). In total, 69.4% had prior fractures. Overall %BMD gain was 12.1% (95% CI 10.5%-13.7%) (LS), 3.6% (95% CI 2.4%-4.7%) (FN), and 3.4% (95% CI 2.5%-4.3%) (TH). Across the three glycaemic categories, %BMD gain did not differ (LS: p = 0.821; FN: p = 0.776; TH: p = 0.985). HbA1c did not correlate with %BMD gain. Baseline BMD T-score and prior antiresorptive treatment were the independent factors inversely associated with %BMD gain. Conclusion: This real-world study showed BMD gains of 12% at the LS and 3.5% at the hip with 12 doses of romosozumab. No statistically significant association was identified between baseline glycaemic category and one-year BMD change during romosozumab treatment. However, the relatively small diabetes subgroup limits the precision of this estimate.

Source: Frontiers in Endocrinology

DOI: 10.3389/fendo.2026.1941784