Comparative bone histomorphometry effects of combined denosumab and teriparatide vs monotherapy in postmenopausal women with osteoporosis: a randomized controlled trial
Authors' conclusion
These findings suggest that the greater increases in BMD observed with combined denosumab and teriparatide in the Denosumab and Teriparatide Administration study may result from the net effect of denosumab-mediated remodeling suppression which leads to a reduction in cortical porosity and enables secondary mineralization of the preserved bone volume and teriparatide-induced bone formation.
Study context
- Population
- Postmenopausal women with osteoporosis26 biopsies analysed
- Participants
- 9 / 13 / 12
- Comparison
- Denosumab plus teriparatide vs denosumab or teriparatide monotherapy
- Denosumabn = 9
- Teriparatiden = 13
- Combinationn = 12
- Primary endpoint
- Within-subject changes from baseline in histomorphometric indices of bone formation (iliac crest biopsy, double fluorochrome labeling)
- Follow-up
- 3 mo
Methodological details3-arm, interventional, Single iliac crest bone biopsy at month 3; changes compared among groups using one-way ANOVA
- 3-arm
- Interventional
- Single iliac crest bone biopsy at month 3; changes compared among groups using one-way ANOVA
Primary result
As reported in the abstract
Histomorphometric indices of bone formation (BFR/BS, MS/BS, dLS/BS)
- Teriparatide significantly increased BFR/BS, MS/BS and dLS/BS compared to denosumab or combination therapy
- Remodeling- and modeling-based bone formation increased in the combination group; denosumab attenuated teriparatide-induced increases in bone formation, except modeling-based bone formation in the endocortical envelope
Original publication
Comparative bone histomorphometry effects of combined denosumab and teriparatide vs monotherapy in postmenopausal women with osteoporosis: a randomized controlled trial. J Bone Miner Res. Published 23 October 2025. doi:10.
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