Romosozumab versus teriparatide for risk of dementia in individuals with osteoporosis: a target trial emulation study
Authors' conclusion
In this target trial emulation study, romosozumab initiation among individuals with osteoporosis may be associated with a lower risk of dementia, particularly Alzheimer's disease, than teriparatide initiation.
Study context
- Population
- Individuals aged ≥ 50 years with osteoporosis newly initiating romosozumab or teriparatide, 2019–2023, Japan (90% female; mean age 81 years)
- Participants
- 69,543 individuals
- Exposure
- Romosozumab initiation vs teriparatide initiation
- Outcome
- Incident dementia
Methodological detailslongitudinal commercial claims data, active comparator, weighted Kaplan-Meier estimator, intention-to-treat and per-protocol analyses
- Longitudinal commercial claims data
- Active comparator
- Weighted Kaplan-Meier estimator
- Intention-to-treat and per-protocol analyses
Main finding
As reported in the abstract
2 years
Absolute risk reduction (ARR)
0.7%
95% confidence interval, - 0.1 to 1.3%
RR
0.91
95% confidence interval, 0.84 to 1.01
Observational data: associations, not effects.
Secondary outcomes
Alzheimer's disease · 2 years
- ARR
- 0.6% (95% confidence interval, 0.0 to 1.1%)
- RR
- 0.88 (95% confidence interval, 0.79 to 1.00)
- Intention-to-treat
Incident dementia · 1 year
- ARR
- 1.0% (95% confidence interval, 0.7 to 1.4%)
- RR
- 0.76 (95% confidence interval, 0.69 to 0.82)
- Per-protocol
Alzheimer's disease · 1 year
- ARR
- 0.6% (95% confidence interval, 0.3 to 0.9%)
- RR
- 0.77 (95% confidence interval, 0.65 to 0.86)
- Per-protocol
Original publication
Romosozumab versus teriparatide for risk of dementia in individuals with osteoporosis: a target trial emulation study. Osteoporos Int. Published 17 April 2026. doi:10.
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