Bone Abstracts

Background: In 2022, NICE recommended romosozumab as a first line therapy for postmenopausal women at very high fracture risk. There is little data describing the impact of this recommendation on clinical practice. Our objective was to describe romosozumab prescribing at the hospital level in comparison to the local population of women aged ≥50 years.

Methods: Across England, Wales and Northern Ireland, the population of women aged ≥50 years was sourced from the Office of National Statistics for 2026. We excluded Trusts/ Health Boards where the local population could not be ascertained (n6). NHS prescriptions for romosozumab were sourced from UCB Prescription Data on file, aggregated at the Trust/ Health Board level from 2022 to 2025. This study assessed romosozumab prescribing rates and uptake across Trusts/Health Boards, those with no prescriptions observed were defined as having no coverage. To compare depth of coverage, we compared local prescriptions per 100,000 women aged ≥50 years. Associations were tested with Spearman correlations. This analysis was limited by the absence of data on the number of NICE-defined eligible patients for romosozumab, necessitating the use of a broader population.

Results: Since 2022, there have been 9,637 patients initiated on romosozumab by 127 NHS Trusts/Health Boards in England, Wales and Northern Ireland. By 2025, romosozumab prescribing increased from 53 to 125 NHS sites, with 86% in Wales, 80% in Northern Ireland, and 94% in England. Approximately 600,000 women aged ≥50 years remained with no apparent access to romosozumab in 2025. The number of local romosozumab prescriptions was significantly correlated with the local number of women aged ≥50 years (r 0.38, P 0.001). In 2025, the median rate of prescriptions was 27.5 per 100,000 women aged ≥50 years and, in sites with at least one romosozumab prescription (n121), varied between 2.4 to 145.3.

Conclusion: In the 3 years following the recommendation of romosozumab for post-menopausal women at very high fracture risk, uptake has improved but over half a million women remain without any access to romosozumab. Even where there is access, prescribing rates varied over 60-fold, highlighting significant opportunities for local service improvement.