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She joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio, before joining 

 You can reach her at mebert@mjhlifesciences.com.

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OBGYN.net Conference CoverageINTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY:Zagreb, Croatia

Prenatal Testing

A recent clinical study presented by Koji Ishikawa, MD, PhD, orthopedic spine surgeon at Duke University, and Tony M. Keaveny, PhD, Founder and Chief Science Officer of O.N. Diagnostics, compared the effects of romosozumab, teriparatide, and denosumab on bone strength in patients with osteoporosis. 

The analysis focused on the hip and spine, where fracture risk is particularly great. Results showed that romosozumab provided substantially greater improvements in bone strength after 1 year of treatment compared to the other 2 drugs. At the spine, for example, romosozumab increased bone density by approximately 25% but boosted bone strength by about 40%, highlighting that strength gains are not fully reflected by bone density measurements from standard DXA scans.

The findings are significant because fracture prevention depends more on improved breaking strength than on density alone. Data from real-world clinical care also suggest even greater percentage gains than those seen in earlier phase-2 and phase-3 trials. 

Notably, romosozumab demonstrated the unique ability to transform highly osteoporotic vertebrae into bones at much lower risk of biomechanical failure, as shown through virtual stress testing models. According to the researchers, romosozumab stands out as the most effective treatment for strengthening both hip and spine bones, offering a compelling advantage over teriparatide and denosumab.

Below, Keaveny shares further details on their presentation 

”(SUN-416) Greater increase in bone strength with romosozumab vs teriparatide or denosumab in women with postmenopausal osteoporosis in real-world clinical setting

 and Ishikawa provides an overview of the presentation 

“(SUN-564) Greater increases in bone strength estimates of virtual bone-implant constructs for spinal surgery with romosozumab vs teriparatide or denosumab in women with postmenopausal osteoporosis”. 

Please provide an overview of your presentation about bone strength from romosozumab vs teriparatide or denosumab.

This study compared the breaking strength of the hip and spine bones for different osteoporosis drug treatments and showed that the strength benefits after 1 year of treatment were substantially greater for romosozumab compared to both teriparatide and denosumab.

Spinal instrumentation remains challenging in patients with bone fragility. The concept behind this project is to provide additional support for achieving favorable surgical outcomes, beyond surgical techniques. Based on simulation-based biomechanical analysis, we found that romosozumab offered multiple advantages over denosumab and teriparatide in terms of biomechanical parameters relevant to spinal surgery.

What is the significance of these findings?

Changes in bone density as measured by clinical-standard DXA testing are difficult to interpret because what matters most in terms of fracture reduction is how much the 

 changes. This study is significant because it demonstrates the substantial benefits for breaking strength – more than for bone density. For example, at the spine, romosozumab increased bone density by about 25% but bone strength by about 40%. So, the benefits of the treatment are underestimated when measured by bone density. And of course, those benefits were greater for romosozumab than either of the other 2 treatments.

Evaluating mechanical parameters such as screw fixation strength or bone-breaking force in clinical practice for assessing drugs effects is impractical and often difficult with traditional biomechanical methods. To address this, we developed a simulation approach using patient CT data. Our findings provide a new perspective on their effectiveness in the context of implant surgery.

What were the main takeaways of your presentation?

As we have seen in other clinical trials, romosozumab is the better treatment in terms of its bone-strengthening benefits, both at the hip and spine. Here we have data from actual clinical care.

After 1 year of treatment, romosozumab showed greater improvements than denosumab and teriparatide in surgical instrumentation-related biomechanical analyses.

What other research about the impact of romosozumab on bone strength would you like to highlight?

These results suggest even greater gains, percentage-wise at least, for these highly osteoporotic and treatment-naïve patients from clinical care than what we observed in a prior phase-2 BCT study in women with low bone mass (Keaveny JBMR 2017) and also in a phase-3 imaging substudy of osteoporotic women with prior bisphosphonate therapy (Langdahl Lancet 2017).

In a previous study, we were the first to demonstrate the potential benefits of short-term romosozumab treatment (3 months) in reducing postoperative complications after spinal surgery (Ishikawa K, JOR Spine 2024). Taken together with the present findings, our research further supports the role of romosozumab for surgical support.

These results are particularly compelling at the spine for romosozumab because the drug benefit is so large — it takes a highly osteoporotic bone and transforms it into one at much lower risk of biomechanical failure. This is seen visually with the virtual stress testing. Here, virtual forces are placed on the bone that would normally fracture and crush an osteoporotic bone. After treatment with romosozumab, that same level of force produces almost no damage in the bone. Romosozumab appears to be the only drug treatment that can transform the osteoporotic vertebra in this way.

Even the best surgeons face complications when patients have osteoporosis. Yet perioperative bone health care is often overlooked. Our studies underscore the importance of assessing and managing bone health in perioperative settings to improve surgical outcomes.

Recent work presented at the 2025 annual meeting of American Society of Bone & Mineral Research found that romosozumab significantly outperformed teriparatide and denosumab in improving hip and spine bone strength. 

Clinical

Romosozumab outperforms teriparatide and denosumab in bone strength

Discover effective strategies and insights to navigate menopause, enhancing well-being and embracing this transformative life stage.

Hormone Therapy Guidelines

For women at midlife with vasomotor and/or genitourinary symptoms of menopause, neither hormone therapy nor complementary alternative medicine (CAM) was linked to an improvement in quality of life (QOL), according to a secondary analysis of the ongoing Study of Women’s Health Across the Nation (SWAN) published in the journal 

However, treatment-by-race/ethnicity interaction was significant for self-reported QOL (

 =.044 longitudinal). Among White women, self-reported QOL was much higher in hormone-therapy users than in those who used neither therapy (

 = .030; 95% CI, 0.01-0.21). By contrast, Black women using hormone therapy only had significantly lower self-reported QOL compared with Black women using neither treatment(

“It was not surprising that White women reported higher use of hormone therapy and higher QOL than Black women,” said Monica Christmas, MD, SWAN’s lead investigator, principal investigator for the analysis, and an associate professor of obstetrics and gynecology at UChicago Medicine in Illinois. “But it was surprising that Black women, who have been shown to have more frequent, severe vasomotor symptoms for longer duration of time, reported lower QOL with use of hormone therapy.”

Christmas, who is also director of the menopause program and the Center for Women’s Integrated Health at UChicagoMedicine, added, “Anecdotally, in my clinical practice over the past 20 years, I have noticed significant racial/ethnic differences in severity and intensity of menopausal symptoms, along with differences in preference for treatment of those symptoms. There is also a paucity of data on menopause care in certain populations.”

Christmas noted that SWAN is an ideal databank because the study recruited a large, racially/ethnically diverse cohort that has been followed for more than 20 years.

“Women were asked if they had menopausal symptoms, and if so, did they take anything to alleviate their symptoms,” Christmas told 

®. “Often participants of studies are only asked what prescription medications they take; however, SWAN asked participants about CAM modalities as well.”

In addition, participants were asked about QOL. “This allowed our team to look into associations between menopause symptoms, treatments, and perceived QOL,” Christmas said.

The cross-sectional and longitudinal analyses of QOL included 2514 women from SWAN who completed a CAM-use questionnaire and QOL assessments at baseline and every 1 to 2 years from 2002 to 2013. During a mean 7.8 years of follow-up, 29% of the cohort reported using hormone therapy for a mean 2.4 years, whereas 32% reported CAM use for a mean 2.1 years.

Christmas noted that the CAM/integrative medicine industry is “booming, despite lack of efficacy in randomized controlled trials. Therefore, clinicians should be counseling patients on the lack of efficacy and possible harm associated with some of these products.”

In addition, recognizing racial/ethnic differences when treating menopausal symptoms is paramount, according to Christmas. “Clinicians should be cognizant of these differences when counseling patients,” she said. “More research is also needed to investigate the basis of these differences. Are they due to patient preference, or are there some inherent biases in
clinician practices?”

Christmas stressed that menopause transition is connected to troublesome symptoms that can have a major impact not only on QOL, but also on professional and personal relationships and overall health and function.

“With life expectancy of over 80 years in developed countries, almost half of a woman’s life could be postmenopausal,” she said. “For symptomatic women, it is imperative we have a better understanding of treatment practices and preferences.” 

Christmas M, Janssen I, Joffe H, Upchurch D, Santoro N, Kravitz HM. Menopause hormone therapy and complementary alternative medicine, quality of life, and racial/ethnic differences: the Study of Women’s Health Across the Nation (SWAN). 

. 2022;29(12):1357-1364. doi:10.1097/GME.0000000000002087

Research reveals that hormone therapy and alternative medicine do not enhance quality of life for midlife women experiencing menopause symptoms.

David Nyberg, MD

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