Romosozumab

How it works

It binds and inhibits sclerostin, which both increases bone formation and decreases bone resorption, producing a dual anabolic and antiresorptive effect.

Prescribing in practice

• It carries an MHRA warning of an increased risk of myocardial infarction, stroke and cardiovascular death, and is contraindicated in patients with a history of myocardial infarction or stroke.
• It is given as a course over a limited period, after which patients should transition to an antiresorptive agent to maintain bone density gains.
• Hypocalcaemia must be corrected before starting, and adequate calcium and vitamin D intake maintained throughout.

Monitoring

Check calcium status before and during treatment and reassess cardiovascular risk before initiation.

Counselling the patient

• Seek urgent help if you develop chest pain, weakness on one side of the body or difficulty speaking.
• This is a time-limited course and will usually be followed by another bone-protecting medicine.
• Continue your calcium and vitamin D as advised.

Evidence & guidelines

The FRAME and ARCH trials showed reduced fracture risk, while ARCH highlighted a cardiovascular safety signal.