Percent changes in L-BMD and H-BMD. Percent changes of L-BMD steadily increased for 12 months in the denosumab monotherapy group (6.0% increase at 12 months) and in the combination group (8.9% increase at 12 months). There was no significant difference between the groups. In the denosumab monotherapy group, there were significant differences at 4, 8 and 12 months, whereas there were significant differences at 8 and 12 months in the combination group, compared with those before treatment (a). Percent changes in H-BMD steadily increased for 12 months in the denosumab monotherapy group (1.2% increase at 12 months) whereas percent changes in H-BMD increased ≤12 months in the combination group (3.6% increase at 12 months). There was a significant difference at 12 months between the two groups. In the denosumab monotherapy group, there was no significant difference, but there was a significant difference at 12 months in the combination group, compared with those before treatment (b). The closed circles represent the denosumab monotherapy group, whereas the closed triangles represent the combination group. Double asterisks or an asterisk denote significant differences (P<0.01 or P<0.05, respectively) at 4, 8 and 12 months, compared with pre-treatment in either the denosumab monotherapy group or the combination group. The hashtag shows significant differences (P<0.05) between the denosumab monotherapy and combination groups at each time point.