Bone Abstracts

Background: Romosozumab is a monoclonal antibody with dual anabolic and antiresorptive effects, offering an important treatment option for patients with severe osteoporosis at high fracture risk. Its use is limited by cost, need for parenteral administration, and concerns regarding cardiovascular safety. We evaluated its effectiveness and tolerability in routine clinical practice.

Methods: We conducted a retrospective study of 22 postmenopausal women treated with Romosozumab in a tertiary osteoporosis service. Patients were aged 4782 years (median 65) and had severe osteoporosis with a major osteoporotic fracture (hip, vertebral, forearm, or humerus) within the previous 24 months. Patients with prior myocardial infarction or stroke were excluded. All underwent cardiovascular risk assessment prior to treatment initiation. Romosozumab was administered for 12 months. Data collected included prior osteoporosis therapies, adverse events, incident fractures, and changes in bone mineral density (BMD) at the hip and lumbar spine.

Results: 13/22 patients had vertebral fractures at baseline. Eighteen had previously received oral bisphosphonates, and three had prior exposure to Teriparatide. Mean baseline T-scores were 2.54 at the hip and 3.78 at the spine. Twenty-one patients completed 12 months of therapy. Treatment was well tolerated, with only mild adverse effects reported (myalgia, n2; injection-site reaction, n1). No cardiovascular events occurred during treatment. Two patients sustained fractures during therapy, both early after initiation. Mean BMD increased by 4.66% at the hip (range 6.6% to 29.3%) and 20.51% at the spine (range 4% to 51.8%).

Conclusion: In this real-world cohort, Romosozumab was associated with substantial improvements in spinal BMD and modest gains at the hip. Treatment was well tolerated, with no observed cardiovascular events in a carefully selected population. These findings support the role of Romosozumab in the management of severe osteoporosis, although longer-term follow-up is required to determine its impact on fracture reduction. Sequential antiresorptive therapy remains essential following treatment.