Real-world comparison of abaloparatide and romosozumab: effects on bone mineral density and three-dimensional hip structure.

UNLABELLED: In a real-world study of postmenopausal women with high-risk osteoporosis, abaloparatide and romosozumab significantly improved bone mineral density and threedimensional hip structural parameters over 12 months, with no significant between-group differences observed. PURPOSE: Direct real-world comparisons between abaloparatide and romosozumab, particularly incorporating structural assessment beyond areal bone mineral density (BMD), remain limited. METHODS: This nationwide multicenter propensity score-matched cohort study compared the effects of abaloparatide and romosozumab on BMD and three-dimensional proximal femur structural parameters in treatment-naïve postmenopausal women with osteoporosis at high fracture risk. Fifty-one matched patients were included in each group. Primary endpoints were percentage changes in lumbar spine (LS), total hip (TH), and femoral neck (FN) BMD over 12 months. Secondary and exploratory endpoints included achievement of T-score thresholds, bone turnover markers, and DXA-based 3D-Shaper structural parameters. Longitudinal changes were assessed using mixed models for repeated measures. RESULTS: Both groups demonstrated significant increases in BMD at all skeletal sites at 12 months (all P < 0.001), with no significant between-group differences. The proportion of patients achieving a T-score > -2.5 increased over time in both groups without significant between-group differences. Exploratory 3D-Shaper analyses demonstrated improvements in several trabecular and cortical structural parameters over 12 months, with no significant between-group differences in any parameter. CONCLUSION: In this real-world propensity score-matched cohort, abaloparatide and romosozumab significantly improved BMD and proximal femur structural parameters over the first 12 months of treatment. No significant between-group differences were observed during this period.