Arthritis Rheumatol

Combination therapy may benefit patients with fractures on denosumab

December 31, 2025

In a 36-month study of 50 postmenopausal women, researchers compared continued denosumab vs. adding romosozumab for 12 months after long-term denosumab. Between-group bone mineral density difference at 12 months was 3.3% (95% confidence interval, –5.2 to 11.8), a non-significant trend favoring combination therapy. However, bone formation marker P1nP rose significantly at 3 months (+22.5 ng/mL; p=0.028), while ongoing denosumab didn't blunt romosozumab’s anabolic effect. Authors conclude that adding romosozumab may be a valuable option for patients who experience a fracture while on denosumab.

Clinical takeaway: Romosozumab can stimulate bone formation even when combined with denosumab, offering a potential strategy for patients with inadequate response.

Source:

Adami G, et al. (2025, December 1). Arthritis Rheumatol. Romosozumab and Denosumab Combination Therapy After Denosumab in Postmenopausal Osteoporosis. https://pubmed.ncbi.nlm.nih.gov/41327832/