A 6-month prospective observational study evaluated the effects of adding romosozumab to ongoing denosumab treatment in postmenopausal women with osteoporosis. The study included 52 participants, divided into three groups: romosozumab alone (n=19), romosozumab combined with ongoing denosumab (n=11), and denosumab alone (n=22). Bone mineral density (BMD) increased significantly at 6 months in the romosozumab alone group, with increases of +8.1% in the femoral neck, +6.8% in the total hip, and +7.9% in the lumbar spine. In contrast, only the lumbar spine showed significant BMD increase in the combination and denosumab groups. Serum P1NP levels increased significantly in both romosozumab groups, with the combination group showing a larger increase. Sclerostin levels rose sharply in both groups, while Dkk1 levels remained unchanged. Calcium levels decreased slightly at month 3 but returned to normal by month 6. PTH levels increased at month 3 but normalized by month 6. The study found that romosozumab added to ongoing denosumab resulted in increased P1NP and lumbar spine BMD, but not femoral neck BMD. For patients on denosumab, romosozumab as an additional treatment improved bone formation markers and spine BMD compared to denosumab alone. However, further randomized controlled trials are needed to confirm these findings. The study highlights the potential benefits of romosozumab in postmenopausal osteoporosis, particularly in improving bone formation markers and spine BMD when added to denosumab. The results suggest that romosozumab may be a useful addition to denosumab treatment for patients with osteoporosis, although the effectiveness at the femoral neck remains unclear. The study also notes that long-term denosumab use may limit the extent of BMD increase with subsequent romosozumab treatment. Overall, the study provides insights into the potential of romosozumab in combination with denosumab for postmenopausal osteoporosis management.A 6-month prospective observational study evaluated the effects of adding romosozumab to ongoing denosumab treatment in postmenopausal women with osteoporosis. The study included 52 participants, divided into three groups: romosozumab alone (n=19), romosozumab combined with ongoing denosumab (n=11), and denosumab alone (n=22). Bone mineral density (BMD) increased significantly at 6 months in the romosozumab alone group, with increases of +8.1% in the femoral neck, +6.8% in the total hip, and +7.9% in the lumbar spine. In contrast, only the lumbar spine showed significant BMD increase in the combination and denosumab groups. Serum P1NP levels increased significantly in both romosozumab groups, with the combination group showing a larger increase. Sclerostin levels rose sharply in both groups, while Dkk1 levels remained unchanged. Calcium levels decreased slightly at month 3 but returned to normal by month 6. PTH levels increased at month 3 but normalized by month 6. The study found that romosozumab added to ongoing denosumab resulted in increased P1NP and lumbar spine BMD, but not femoral neck BMD. For patients on denosumab, romosozumab as an additional treatment improved bone formation markers and spine BMD compared to denosumab alone. However, further randomized controlled trials are needed to confirm these findings. The study highlights the potential benefits of romosozumab in postmenopausal osteoporosis, particularly in improving bone formation markers and spine BMD when added to denosumab. The results suggest that romosozumab may be a useful addition to denosumab treatment for patients with osteoporosis, although the effectiveness at the femoral neck remains unclear. The study also notes that long-term denosumab use may limit the extent of BMD increase with subsequent romosozumab treatment. Overall, the study provides insights into the potential of romosozumab in combination with denosumab for postmenopausal osteoporosis management.