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Osteoporosis — SCE Rheumatology MCQ

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HardMetabolic Bone DiseaseOsteoporosisSCE Rheumatology

A 75-year-old woman with osteoporosis (T-score -3.5) and vertebral fractures is started on Romosozumab. What is the mechanism of action of Romosozumab and what is a key safety consideration?

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Correct answer: D — Sclerostin inhibition increasing formation while reducing resorption

The best answer is “Sclerostin inhibition increasing formation while reducing resorption”. Romosozumab is a monoclonal antibody that inhibits sclerostin, a glycoprotein that negatively regulates bone formation via the Wnt pathway. It has a dual mechanism: increasing bone formation and reducing resorption. The ARCH trial demonstrated superiority over Alendronate for fracture reduction. However, cardiovascular safety is a concern — Romosozumab is not recommended in patients who have had a cardiovascular event in the past year. Treatment duration is limited to 12 monthly doses, after which transition to anti-resorptive therapy is required. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: NICE TA791 romosozumab for severe osteoporosis: https://www.nice.org.uk/guidance/ta791