{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:24:37Z","timestamp":1787009077386,"version":"build-2736575974"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Osteoporosis is a major complication of thalassemia bone disease, leading to increased fracture risk and impaired quality of life. Anti-resorptive agents, such as bisphosphonates and denosumab, have shown efficacy in randomized trials, but data are scarce, regarding the role of anabolic agents in severe cases with fragility fractures. We report 2 cases with severe osteoporosis associated to thalassemia with multiple vertebral and non-vertebral fractures, despite long term-treatment with anti-resorptive agents. Both patients were initiated on subcutaneous romosozumab (210\u00a0mg once monthly) for 12\u00a0mo. At 12\u00a0mo, BMD showed marked improvement at the LS by 6.8%-15.4%, TH by 14.6%, and FN by 8.7%-24.6%. Bone turnover markers changed in line with clinical trials of postmenopausal osteoporosis. No adverse events occurred during the treatment period. Following completion of romosozumab therapy, each patient received a single infusion of zoledronate to consolidate the bone mass gained. Over 24\u00a0mo follow-up, no new fragility fractures were observed. Romosozumab can be an effective and safe anabolic option for patients with thalassemia and high fracture risk. While anti-resorptive therapy remains the standard of care, romosozumab may provide additional benefit in thalassemia patients with severe osteoporosis and increased fracture risk.<\/jats:p>","DOI":"10.1093\/jbmrpl\/ziag020","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:46:30Z","timestamp":1770295590000},"source":"Crossref","is-referenced-by-count":2,"title":["Romosozumab for the treatment of thalassemia-associated osteoporosis in two female patients"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6501-3692","authenticated-orcid":false,"given":"Maria P","family":"Yavropoulou","sequence":"first","affiliation":[{"name":"Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, LAIKO University Hospital, C.E.R.E.D, ENDO-ERN Center , Athens 11527,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6898-1357","authenticated-orcid":false,"given":"Maria-Evangelia","family":"Koloutsou","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, LAIKO University Hospital, C.E.R.E.D, ENDO-ERN Center , Athens 11527,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Polyxeni","family":"Delaporta","sequence":"additional","affiliation":[{"name":"Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, \u2018Aghia Sophia\u2019 Children\u2019s Hospital, ERN-EuroBloodNet Center , Athens 11527 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3231-3357","authenticated-orcid":false,"given":"Polyzois","family":"Makras","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes and Department of Medical Research, 251 Hellenic Air Force & VA General Hospital , Athens 11525 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9624-6296","authenticated-orcid":false,"given":"Athanasios D","family":"Anastasilakis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, 424 Military General Hospital , Thessaloniki 56429 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Kassi","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, LAIKO University Hospital, C.E.R.E.D, ENDO-ERN Center , Athens 11527,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonis","family":"Kattamis","sequence":"additional","affiliation":[{"name":"Thalassemia Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, \u2018Aghia Sophia\u2019 Children\u2019s Hospital, ERN-EuroBloodNet Center , Athens 11527 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevi","family":"Xekouki","sequence":"additional","affiliation":[{"name":"Endocrinology and Diabetes Clinic, University Hospital of Heraklion, School of Medicine, University of Crete , 71500 Crete ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"issue":"11","key":"2026042109062879400_ref1","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1056\/NEJMra050436","article-title":"Beta-thalassemia","volume":"353","author":"Rund","year":"2005","journal-title":"N Engl J Med"},{"issue":"3","key":"2026042109062879400_ref2","doi-asserted-by":"publisher","first-page":"e70095","DOI":"10.1002\/hem3.70095","article-title":"TIF Guidelines for the Management of Transfusion-Dependent Beta-Thalassemia","volume":"9","author":"Musallam","year":"2025","journal-title":"Hemasphere."},{"issue":"1","key":"2026042109062879400_ref3","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1182\/asheducation-2017.1.272","article-title":"Impact of bone disease and pain in thalassemia","volume":"2017","author":"Piga","year":"2017","journal-title":"Hematology Am Soc Hematol Educ Program"},{"issue":"5","key":"2026042109062879400_ref4","doi-asserted-by":"publisher","first-page":"e2022305","DOI":"10.23750\/abm.v93i5.13668","article-title":"Approach to the management of beta thalassemia major associated osteoporosis - a long-standing relationship revisited","volume":"93","author":"Yavropoulou","year":"2022","journal-title":"Acta Biomed"},{"issue":"4","key":"2026042109062879400_ref5","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1007\/s40618-024-02503-2","article-title":"Aetiology, diagnosis and treatment of thalassemia-associated osteoporosis of the adult","volume":"48","author":"Ambrosio","year":"2025","journal-title":"J Endocrinol Investig"},{"issue":"5","key":"2026042109062879400_ref6","doi-asserted-by":"publisher","first-page":"CD010429","DOI":"10.1002\/14651858.CD010429.pub3","article-title":"Treatment for osteoporosis in people with beta-thalassaemia","volume":"5","author":"Bhardwaj","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"2026042109062879400_ref7","doi-asserted-by":"publisher","first-page":"e2023178","DOI":"10.23750\/abm.v94i3.14805","article-title":"Recent advancements in glucose dysregulation and pharmacological management of osteoporosis in transfusion-dependent thalassemia (TDT): an update of ICET-A (International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine)","volume":"94","author":"Tzoulis","year":"2023","journal-title":"Acta Biomed"},{"issue":"12","key":"2026042109062879400_ref8","doi-asserted-by":"publisher","first-page":"2905","DOI":"10.1111\/trf.13237","article-title":"Effects of teriparatide retreatment in a patient with beta-thalassemia major","volume":"55","author":"Tournis","year":"2015","journal-title":"Transfusion."},{"key":"2026042109062879400_ref9","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1007\/s00223-022-00963-3","article-title":"Efficacy and safety of teriparatide in beta-thalassemia major associated osteoporosis: a real-life experience","volume":"111","author":"Gagliardi","year":"2022","journal-title":"Calcif Tissue Int"},{"issue":"2","key":"2026042109062879400_ref10","doi-asserted-by":"publisher","first-page":"119","DOI":"10.4081\/reumatismo.2010.119","article-title":"Anabolic therapy of induced osteoporosis in beta-thalassaemia major: case report and literature review","volume":"62","author":"Trotta","year":"2010","journal-title":"Reumatismo"},{"issue":"1","key":"2026042109062879400_ref11","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s11657-019-0584-3","article-title":"The 2018 Guidelines for the diagnosis and treatment of osteoporosis in Greece","volume":"14","author":"Makras","year":"2019","journal-title":"Arch Osteoporos"},{"key":"2026042109062879400_ref12","doi-asserted-by":"publisher","first-page":"1178761","DOI":"10.3389\/fendo.2023.1178761","article-title":"The efficacy of alendronate for the treatment of thalassemia-associated osteoporosis: a randomized controlled trial","volume":"14","author":"Piriyakhuntorn","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"4","key":"2026042109062879400_ref13","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1046\/j.1365-2141.2003.04657.x","article-title":"Pamidronate is an effective treatment for osteoporosis in patients with beta-thalassaemia","volume":"123","author":"Voskaridou","year":"2003","journal-title":"Br J Haematol"},{"issue":"9","key":"2026042109062879400_ref14","first-page":"1193","article-title":"Zoledronic acid for the treatment of osteoporosis in patients with beta-thalassemia: results from a single-center, randomized, placebo-controlled trial","volume":"91","author":"Voskaridou","year":"2006","journal-title":"Haematologica."},{"issue":"8","key":"2026042109062879400_ref15","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1007\/s001980200087","article-title":"Bisphosphonates in the treatment of thalassemia-induced osteoporosis","volume":"13","author":"Morabito","year":"2002","journal-title":"Osteoporos Int"},{"issue":"21","key":"2026042109062879400_ref16","doi-asserted-by":"publisher","first-page":"2837","DOI":"10.1182\/bloodadvances.2018023085","article-title":"Denosumab in transfusion-dependent thalassemia osteoporosis: a randomized, placebo-controlled, double-blind phase 2b clinical trial","volume":"2","author":"Voskaridou","year":"2018","journal-title":"Blood Adv"},{"issue":"4","key":"2026042109062879400_ref17","doi-asserted-by":"publisher","first-page":"546","DOI":"10.4103\/2230-8210.137516","article-title":"Effects of the anti-receptor activator of nuclear factor kappa B ligand denusomab on beta thalassemia major-induced osteoporosis","volume":"18","author":"Yassin","year":"2014","journal-title":"Indian J Endocrinol Metab"},{"issue":"1","key":"2026042109062879400_ref18","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1111\/j.1365-2141.2004.04871.x","article-title":"Treatment of beta-thalassaemia-associated osteoporosis with zoledronic acid","volume":"125","author":"Perifanis","year":"2004","journal-title":"Br J Haematol"},{"issue":"1","key":"2026042109062879400_ref19","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s00277-006-0180-7","article-title":"Effect of zoledronic acid on markers of bone turnover and mineral density in osteoporotic patients with beta-thalassaemia","volume":"86","author":"Perifanis","year":"2007","journal-title":"Ann Hematol"},{"issue":"4","key":"2026042109062879400_ref20","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1007\/s12288-018-0953-x","article-title":"Zoledronic acid for treatment of low bone mineral density in patients with beta thalassemia major","volume":"34","author":"Naithani","year":"2018","journal-title":"Indian J Hematol Blood Transfus"},{"issue":"9","key":"2026042109062879400_ref21","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1007\/s00277-006-0136-y","article-title":"Intravenous zoledronic acid treatment in thalassemia-induced osteoporosis: results of a phase II clinical trial","volume":"85","author":"Otrock","year":"2006","journal-title":"Ann Hematol"},{"issue":"3","key":"2026042109062879400_ref22","doi-asserted-by":"publisher","first-page":"170","DOI":"10.5455\/medarh.2018.72.170-173","article-title":"Administration of intravenous zoledronic acid every 3 months vs. annually in beta-thalassemia patients with low bone mineral density: a retrospective comparison of efficacy","volume":"72","author":"Darvishi-Khezri","year":"2018","journal-title":"Med Arch"},{"issue":"1","key":"2026042109062879400_ref23","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s00198-009-0875-4","article-title":"Bone recovery after zoledronate therapy in thalassemia-induced osteoporosis: a meta-analysis and systematic review","volume":"21","author":"Mamtani","year":"2010","journal-title":"Osteoporos Int"},{"issue":"10","key":"2026042109062879400_ref24","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.3324\/haematol.12849","article-title":"Continuous improvement of bone mineral density two years post zoledronic acid discontinuation in patients with thalassemia-induced osteoporosis: long-term follow-up of a randomized, placebo-controlled trial","volume":"93","author":"Voskaridou","year":"2008","journal-title":"Haematologica."},{"issue":"15","key":"2026042109062879400_ref25","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1056\/NEJMoa1708322","article-title":"Romosozumab or alendronate for fracture prevention in women with osteoporosis","volume":"377","author":"Saag","year":"2017","journal-title":"N Engl J Med"},{"issue":"7","key":"2026042109062879400_ref26","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1001\/jama.2016.11136","article-title":"Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial","volume":"316","author":"Miller","year":"2016","journal-title":"JAMA."},{"issue":"10117","key":"2026042109062879400_ref27","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/S0140-6736(17)32137-2","article-title":"Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial","volume":"391","author":"Kendler","year":"2018","journal-title":"Lancet."},{"issue":"2","key":"2026042109062879400_ref28","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1016\/j.bone.2012.09.016","article-title":"Effects of PTH on osteocyte function","volume":"54","author":"Bellido","year":"2013","journal-title":"Bone."},{"issue":"12","key":"2026042109062879400_ref29","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1055\/s-0032-1312618","article-title":"High circulating sclerostin is present in patients with thalassemia-associated osteoporosis and correlates with bone mineral density","volume":"44","author":"Voskaridou","year":"2012","journal-title":"Horm Metab Res"},{"key":"2026042109062879400_ref30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.bone.2017.01.019","article-title":"Sclerostin: from bedside to bench, and back to bedside","volume":"96","author":"Robling","year":"2017","journal-title":"Bone."},{"key":"2026042109062879400_ref31","doi-asserted-by":"publisher","first-page":"116511","DOI":"10.1016\/j.bone.2022.116511","article-title":"Iron overload induced osteocytes apoptosis and led to bone loss in hepcidin(\u2212\/\u2212) mice through increasing sclerostin and RANKL\/OPG","volume":"164","author":"Ma","year":"2022","journal-title":"Bone."},{"issue":"5","key":"2026042109062879400_ref32","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1056\/NEJMoa1305224","article-title":"Romosozumab in postmenopausal women with low bone mineral density","volume":"370","author":"McClung","year":"2014","journal-title":"N Engl J Med"},{"issue":"16","key":"2026042109062879400_ref33","doi-asserted-by":"publisher","first-page":"1532","DOI":"10.1056\/NEJMoa1607948","article-title":"Romosozumab treatment in postmenopausal women with osteoporosis","volume":"375","author":"Cosman","year":"2016","journal-title":"N Engl J Med"},{"key":"2026042109062879400_ref34","doi-asserted-by":"publisher","DOI":"10.1093\/jbmr\/zjaf164","article-title":"Considerations regarding the use of Romosozumab in a patient at high risk for cardiovascular disease","author":"McClung","year":"2025","journal-title":"J Bone Miner Res"},{"issue":"Suppl 1","key":"2026042109062879400_ref35","doi-asserted-by":"publisher","first-page":"S81","DOI":"10.3109\/03630260903347526","article-title":"Cardiac complications in thalassemia major","volume":"33 Suppl 1","author":"Wood","year":"2009","journal-title":"Hemoglobin."}],"container-title":["JBMR Plus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbmrplus\/advance-article-pdf\/doi\/10.1093\/jbmrpl\/ziag020\/66781627\/ziag020.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmrplus\/article-pdf\/10\/5\/ziag020\/66781627\/ziag020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmrplus\/article-pdf\/10\/5\/ziag020\/66781627\/ziag020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T13:06:34Z","timestamp":1776776794000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmrplus\/article\/doi\/10.1093\/jbmrpl\/ziag020\/8464195"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4,2]]}},"URL":"https:\/\/doi.org\/10.1093\/jbmrpl\/ziag020","relation":{},"ISSN":["2473-4039"],"issn-type":[{"value":"2473-4039","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,3,17]]},"article-number":"ziag020"}}