For a patient who would benefit from an anabolic agent for osteoporosis, do you prefer romosuzumab over teriparatide in the absence of contraindications to either agent?

Both teriparatide and romozosumab are excellent drugs to treat osteoporosis with documented risk reduction in fractures. TPTD reduces spine fracture about 85% and romozosumab about 75%. Both are excellent.

They have very different biologies with TPTD being a remodeling-based anabolic and romozosumab...

I agree with @Dr. First Last, once the decision to use an anabolic has been made insurance becomes the determining factor. For commercial insurance, they will generally approve a PTH agent over Romo. For Medicare Romo is generally more affordable if they are not on and Advantage plan. If they are ev...

Agree that the costs/insurance coverage, the patient's preference for daily injectable guides my treatment plan. I encourage and try to do PTH analog followed by sclerostin inhibitor if the patient and insurance agreeable.