{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T03:57:33Z","timestamp":1794542253119,"version":"4.9.1"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Romosozumab is a monoclonal antibody against sclerostin that initially exhibits potent anabolic effects in treating osteoporosis. However, its efficacy diminishes after 6 mo, with bone formation markers declining despite continued therapy. We hypothesized that increased levels of Dickkopf-1 (Dkk1), a Wnt pathway inhibitor, may contribute to this attenuation by suppressing osteoblast activity. We conducted a 12-mo prospective observational study on postmenopausal osteoporosis na\u00efve to anti-osteoporosis treatment treated with romosozumab. Serum levels of Dkk1, procollagen type I N-terminal propeptide (P1NP), C-terminal telopeptide of type I collagen (CTX), and sclerostin were measured at baseline (M0) and at 3 (M3), 6 (M6), and 12 mo (M12). BMD at the LS, FN, and TH was assessed at M0, M6, and M12. Associations between Dkk1 and P1NP were analyzed using linear mixed-effects models. Dkk1 levels increased significantly from 38.9\u00a0pmol\/L at M0 to 44.2\u00a0pmol\/L at M12 (p\u2009=\u2009.003). P1NP increased from 89.4\u00a0ng\/mL at M0 to 115.4\u00a0ng\/mL at M3 (p\u2009=\u2009.004) but decreased to 61.5\u00a0ng\/mL by M12 (p\u2009&amp;lt;\u2009.001). CTX decreased significantly throughout the study (p\u2009&amp;lt;\u2009.001). BMD increased significantly at all sites by M12 (LS\u2009+\u200913.8%, FN\u2009+\u20096.3%, TH\u2009+\u20094.7%; all p\u2009&amp;lt;\u2009.01). An inverse association was found between Dkk1 increase and P1NP decrease between M3 and M12 (estimate\u2009=\u2009\u22120.909; p\u2009=\u2009.032). Romosozumab treatment is associated with a significant rise in Dkk1 levels, which correlates with a decrease in bone formation markers over time. Dkk1 may attenuate the anabolic effects of romosozumab by inhibiting Wnt signaling.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf110","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T11:47:52Z","timestamp":1755085672000},"page":"143-149","source":"Crossref","is-referenced-by-count":9,"title":["Increase in serum DKK1 levels attenuates the anabolic response to romosozumab in postmenopausal osteoporosis"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8915-0755","authenticated-orcid":false,"given":"Giovanni","family":"Adami","sequence":"first","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Montanari","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9187-232X","authenticated-orcid":false,"given":"Angelo","family":"Fassio","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pollastri","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Piccinelli","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Benini","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Pasetto","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Tugnolli","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Gatti","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Rossini","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ombretta","family":"Viapiana","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, University of Verona , 37134 Verona ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"issue":"3","key":"2026020308315694100_ref1","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1056\/NEJMcp1513724","article-title":"Clinical practice. 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