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Postmenopausal severe osteoporosis following romosozumab treatment — SCE Rheumatology MCQ

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ModerateOsteoporosisPostmenopausal severe osteoporosis following romosozumab treatmentSCE Rheumatology

A 72-year-old postmenopausal woman was referred after a painful T12 vertebral fragility fracture. Her femoral-neck T-score was −3.4, and she had no history of myocardial infarction or stroke. After correction of vitamin D deficiency, she started romosozumab 210 mg subcutaneously once monthly. She has now received her twelfth monthly dose. She has sustained no further fractures, and her femoral-neck T-score has improved to −2.6. Serum calcium, 25-hydroxyvitamin D and renal function are satisfactory. She asks whether the improvement means that pharmacological treatment can now be stopped. Which is the most appropriate disease-modifying treatment plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Stop romosozumab after 12 months and commence antiresorptive therapy promptly

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

Romosozumab is prescribed as a 12-month course. On completion, the patient should transition promptly to an antiresorptive agent to preserve and extend the skeletal benefit. Her improved T-score and absence of an interval fracture indicate treatment response but do not justify an untreated interval; she remains osteoporotic and has a previous vertebral fracture. A is incorrect because routine romosozumab treatment should not be extended beyond the licensed 12-month course. B and E incorrectly defer consolidation until measurable bone loss has occurred: the recommended sequence is planned antiresorptive treatment after romosozumab, rather than surveillance followed by reactive treatment. C is inappropriate because sequential use of another bone-forming drug is not the recommended consolidation strategy after romosozumab. Abaloparatide is an alternative anabolic option for selected people at very high fracture risk, not the standard treatment immediately following a completed romosozumab course. The specific antiresorptive should be selected according to factors such as gastrointestinal suitability, renal function, adherence and prior treatment. The decisive issue in this case is the timing and therapeutic class of the next treatment, rather than the choice between individual antiresorptive agents.

Reference: EVENITY 105 mg solution for injection in pre-filled pen — Summary of Product Characteristics (Updated 4 November 2024) — https://www.medicines.org.uk/emc/product/10956/smpc Romosozumab for treating severe osteoporosis — NICE technology appraisal guidance TA791 (25 May 2022) — https://www.nice.org.uk/guidance/ta791/chapter/1-Recommendations Romosozumab for treating severe osteoporosis — Committee discussion (25 May 2022) — https://www.nice.org.uk/guidance/ta791/chapter/3-Committee-discussion