骨粗鬆症治療薬における変形性関節症発生リスクの比較研究~ロモソズマブは変形性関節症発生リスク低減~

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2025-07-11 東京大学

骨粗鬆症治療薬における変形性関節症発生リスクの比較研究~ロモソズマブは変形性関節症発生リスク低減~

東京大学の研究チームは、日本人の骨粗鬆症患者を対象に、新規投与されたロモソズマブとテリパラチドの間で変形性関節症の発生リスクを比較しました。その結果、ロモソズマブ投与群の方が変形性関節症(膝、股、手指)発生リスクが低いことが明らかとなりました。ロモソズマブは骨形成促進と骨吸収抑制の二重作用を持つヒト型モノクローナル抗体製剤であり、本研究は同薬剤が関節症リスク低減にも寄与する可能性を示した初の臨床エビデンスとして、今後の治療選択における重要な知見となります。

<関連情報>

骨粗鬆症患者におけるテリパラチドと比較したロモソズマブの変形性関節症リスク:標的試験エミュレーション研究 Osteoarthritis risk associated with romosozumab compared with teriparatide in individuals with osteoporosis: a target trial emulation study

Masaki Hatano ∙ Yusuke Sasabuchi ∙ Akira Okada ∙ … ∙ Taku Saito ∙ Sakae Tanaka ∙ Hideo Yasunaga
Annals of the Rheumatic Diseases  Published: July 11, 2025
DOI:https://doi.org/10.1016/j.ard.2025.06.2124

ABSTRACT

Objectives

To compare osteoarthritis among individuals with osteoporosis initiating romosozumab vs an active comparator.

Methods

This new user comparative effectiveness study, emulating a target trial, included individuals aged ≥50 years in the administrative claims database from 2019 to 2022. Individuals who initiated romosozumab were compared with those who initiated teriparatide. The primary outcome was the incidence of osteoarthritis, while secondary outcomes included joint-specific osteoarthritis (knee, hip, and hand) at 1 year. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between romosozumab and teriparatide users, and inverse probability of censoring weighting (IPCW) was employed to account for informative censoring. Absolute risk reduction (ARR) and relative risk (RR) at 1 year were estimated using a weighted Kaplan-Meier estimator.

Results

A total of 22,145 individuals were included in the study (87% female; mean age, 80 years). After IPTW-IPCW adjustment, romosozumab was associated with a lower risk of osteoarthritis compared with teriparatide (ARR, 1.1% [95% CI, 0.5%-1.8%]; RR, 0.79 [0.66, 0.89]). Joint-specific analyses showed the following results: knee osteoarthritis: ARR, 0.8% (95% CI, 0.3%-1.5%), RR, 0.79 (0.66, 0.92); hip osteoarthritis: ARR, 0.2% (95% CI, 0.0%-0.5%), RR, 0.68 (0.37, 1.05); and hand osteoarthritis: ARR, 0.2% (95% CI, 0.0%-0.4%), RR, 0.61 (0.35, 1.06).

Conclusions

Romosozumab was associated with a lower risk of osteoarthritis than teriparatide among individuals with osteoporosis, particularly for knee osteoarthritis. Similar trends were observed for hip and hand osteoarthritis; however, the differences were not significant.

医療・健康
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