Bone Abstracts

Background: Romosozumab was approved by NICE in May 2022 for postmenopausal women at very high fracture risk. However, real-world data on its use and adherence within the NHS remain limited. The local NHS Trust introduced a pharmacist and clinical nurse specialist (CNS)-led Virtual Osteoporosis Clinic (VOC) to review referrals and authorise injectable treatments, including romosozumab. This study aimed to evaluate service performance and patient-reported adherence. The objectives were to: 1) assess patient adherence; 2) evaluate compliance with NICE TA791 and safety requirements; and 3) assess efficiency from referral to treatment.

Methods: A retrospective review included all romosozumab referrals assessed by the VOC between November 2022 and 31 August 2025. Data were obtained from clinic records, laboratory results, and a local database. Outcomes included NICE eligibility, QRISK3 cardiovascular risk, and safety checks. Time intervals from referral to review, approval, and first dose were analysed. Adherence was measured using the MARS-5 postal survey, with scores below 24 indicating non-adherence.

Results: A total of 104 patients were referred (mean age 73.6 years). Six patients declined treatment, and two experienced myocardial infarction before initiation. Eighty patients commenced therapy, with 34 completing 12 months. A total of 56 surveys were sent, of which 39 were returned. Thirty-five patients were adherent (89.7%). Feedback was generally positive, although some patients reported uncertainty about treatment benefit. All patients met NICE eligibility and safety criteria. QRISK3 was calculated for 96 patients, with no significantly high cardiovascular risk identified. All had an eGFR above 30 mL/min/1.73 m² at approval, with no cases of hypocalcaemia or vitamin D deficiency. The median time from referral to first dose was 71.5 days. The median time from referral to VOC review was 23 days. Approval was rapid (mean 8.2 days), with 75% approved on the same day. The longest delay occurred between approval and first dose, mainly due to local administrative delays and homecare processes.

Conclusion: This pharmacist and CNS-led model supported the safe use of romosozumab in line with NICE guidance, with high adherence. Delays between approval and treatment highlight the need to streamline local administrative and homecare processes to improve timely access.