Romosozumab super-responders in clinical practice: insights from a large Italian multicenter cohort of women with severe postmenopausal osteoporosis
Authors' conclusion
Romosozumab demonstrated high effectiveness in this real-world cohort, with a substantial proportion achieving high-magnitude BMD responses despite extensive prior treatment. Distinct site-specific predictors emerged: bone turnover and age/Z-score for LS, prior femoral fracture for FN.
Study context
- Population
- Postmenopausal women with severe osteoporosis who completed 12 months of romosozumab, five Italian centresmean age 69.4 ± 9.9 years
- Participants
- 149 women
- Outcome
- Romosozumab effectiveness (BMD gain) and predictors of high-magnitude densitometric response (super-responders ≥ 20% BMD gain)
- Follow-up
- 12 months
Methodological detailsmulticentre, real-world, multivariate logistic regression
- Multicentre
- Real-world
- Multivariate logistic regression
Main finding
As reported in the abstract
Mean BMD gain
- Mean BMD gain at lumbar spine (LS)
- + 13.7%
- Mean BMD gain at femoral neck (FN)
- + 5.9%
- Mean BMD gain at total hip (TH)
- + 4.4%
- Very good responders (≥ 10%) at LS
- 65.2%
- Very good responders (≥ 10%) at FN
- 17.8%
- Very good responders (≥ 10%) at TH
- 13.3%
- Super-responders (≥ 20%) at LS
- 17.8%
- Super-responders (≥ 20%) at FN
- 5.9%
Observational data: associations, not effects.
Further findings
Independent predictors of LS super-response
- Higher baseline CTX, OR
- 1.42; p = 0.018
- Older age, OR per year
- 1.10; p = 0.036
- Lower baseline LS Z-score, OR
- 0.29; p = 0.003
- Multivariate logistic regression
Independent predictor of FN super-response
- Prior femoral fracture, OR
- 14.6; p = 0.020
- Multivariate logistic regression
Original publication
Romosozumab super-responders in clinical practice: insights from a large Italian multicenter cohort of women with severe postmenopausal osteoporosis. Osteoporos Int. Published 14 April 2026. doi:10.
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