Bone Abstracts

Background: Osteoporosis is a major cause of fragility fractures, contributing significantly to morbidity, mortality, and healthcare burden. Patients at very high fracture risk, particularly those with recent or multiple vertebral fractures, have a high imminent risk of re-fracture and may benefit from early anabolic therapy. Osteoanabolic agents such as romosozumab and teriparatide improve bone mineral density and reduce fracture risk. Guidance has evolved. Earlier National Institute for Health and Care Excellence (NICE 2018) restricted teriparatide, whereas NICE (2022) expanded access to romosozumab. National Osteoporosis Guideline Group (NOGG 2024) supports earlier, risk-based anabolic therapy. These differences may influence prescribing practice.

Methods: This retrospective audit was conducted at a single secondary care centre. All patients prescribed romosozumab or teriparatide between January and December 2024 were identified from a biologics database. Clinical data from electronic records, including DEXA reports and clinic correspondence, captured bone mineral density, fracture history, and treatment indication. Patients were assessed against National Institute for Health and Care Excellence (NICE 2018/2022) and National Osteoporosis Guideline Group (NOGG 2024) criteria. Outcomes included guideline concordance and adverse effects.

Results: A total of 34 patients were included (romosozumab n15; teriparatide n19). Among teriparatide patients, 8/19 (42%) met NICE 2018 criteria, compared with 16/19 (84%) meeting NICE 2022 and 19/19 (100%) meeting NOGG 2024 criteria. All romosozumab patients (15/15, 100%) met NICE 2022 and NOGG 2024 criteria, while only 7/15 (47%) met NICE 2018 criteria. Adverse effects were infrequent. Romosozumab was associated with joint pain (13%) and flu-like symptoms (7%), with one discontinuation. Teriparatide caused mild dizziness with no discontinuations.

Conclusion: Prescribing of romosozumab and teriparatide was aligned with contemporary guidance, with all patients meeting NOGG 2024 criteria and all romosozumab prescriptions compliant with NICE 2022. In contrast, NICE 2018 criteria would have excluded a substantial proportion of eligible patients. These findings highlight a shift towards earlier, risk-stratified anabolic therapy and support adoption of NOGG-based approaches to improve equitable and timely access. Alignment of commissioning policies with updated guidance is essential to optimise outcomes in very high-risk patients.