Optimising the identification and initiation of romosozumab treatment for eligible patients within a fracture prevention service

Rachel Eckert; Jacalyn Elliott; Isabella Farrance; Patsy Stevens; Jane Kelly; Joanne Livingstone; Danielle Bishop; Susan Morris; Carmelita Pestana-Sousa; Karen Taylor; Litty Kunju; MK Javaid; Sarah Connacher

doi:10.1530/obabs.08.OC2.9

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Bone Abstracts (2026) 8 OC2.9 | DOI: 10.1530/obabs.08.OC2.9

OP2026 Oral Communications Oral Communications 2: Quality Improvement Projects (15 abstracts)

Optimising the identification and initiation of romosozumab treatment for eligible patients within a fracture prevention service

Rachel Eckert ¹ , Jacalyn Elliott ¹ , Isabella Farrance ² , Patsy Stevens ¹ , Jane Kelly ¹ , Joanne Livingstone ¹ , Danielle Bishop ¹ , Susan Morris ¹ , Carmelita Pestana-Sousa ¹ , Karen Taylor ¹ , Litty Kunju ¹ , MK Javaid ^1,3 & Sarah Connacher ¹

Author affiliations

¹Oxfordshire Fracture Prevention Service, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom;²University of Oxford, Oxford, United Kingdom;³NDORMS, University of Oxford, Oxford, United Kingdom

Background: The National Institute for Health and Care Excellence guidelines endorse romosozumab as an effective anabolic therapy for treating severe osteoporosis in postmenopausal women at very high risk of fragility fractures. It offers significant improvements in bone mineral density and reduction in fracture risk. However, despite its proven efficacy, the initiation of romosozumab within fracture prevention services remains inconsistent.

Methods: We employed a multi-faceted approach to improve service delivery starting with process mapping to identify potential barriers to systematically deliver romosozumab using the National Osteoporosis Guidelines Group (NOGG) thresholds. Key strategies in implementation were refining cardiovascular risk assessment pathways using QRISK3 questions, workforce training to improve knowledge and confidence, excluding below knee fragility fractures to provide capacity to fast-track higher fracture risk patients, closer multidisciplinary team collaboration with the osteoporosis clinic and regular reporting to the fracture liaison service governance meeting that included 3 patient partners. We also advocated for a shift in clinical mindset, prioritising anabolic therapy as a first-line treatment, even in patients with hip fractures.

Results: 360 eligible patients have been reviewed with a mean age 72.6 years (range 43 to 96 years). 52.5% were index spine fracture, 28.6% wrist, 11.9% humerus and 5.3% hip fractures. 75.8% were not on any anti-osteoporosis medication (AOM) at time of the index fracture and 58.4% reported no prior AOM use. In terms of cardiovascular risk factors, 18 (4.3%) had diabetes, 10 (2.8%) had a high HbA1c ( 48mM), 36 (10%) had a family history of heart disease under the age of 60 years and 17 (4.7%) were current smokers. Over 90% of patients presented to the multidisciplinary team went on to initiate romosozumab.

Conclusion: Integrating romosozumab into routine practice within fracture prevention services is achievable and associated with sustainable increase in treatment initiation rates, contributing to improved fracture prevention. Further work is required to continue optimising treatment pathways especially for patients with an index hip fracture.