Endocrine Abstracts

Background: Romosozumab, a dual-action anabolic and anti-resorptive therapy, was approved for NHS use in England and Wales in 2022 for the treatment of severe osteoporosis. Despite robust trial data, real-world UK evidence remains limited, particularly regarding patient selection, bone turnover responses, and early fracture outcomes in high-risk postmenopausal women.

Objective: To evaluate 12-month experience of romosozumab in a real-world NHS setting at a large tertiary metabolic bone centre.

Methods: We performed a retrospective analysis of prospectively collected data from postmenopausal women with severe osteoporosis treated at the Queen Elizabeth Hospital Birmingham. Eligibility reflected NICE TA791 criteria: mean baseline T-score –3.58 (spine) and –2.46 (hip), with ≥1 fragility fracture within 24 months or very high FRAX risk. Patients with prior myocardial infarction or stroke were excluded. Baseline QRISK scores were recorded (mean 9.0%±4.42). Changes in bone turnover markers (P1NP, CTX), biochemical parameters, 12-month BMD (DXA), and incident fragility fractures were assessed.

Results: Twenty-seven women (mean age 64±7 years) completed 12 months of romosozumab. Significant BMD gains were observed at the lumbar spine (mean T-score –2.64; +14%) and total hip (–2.04; +5%). P1NP rose to 62.09 μg/l, while CTX fell to 0.27 pg/mL, demonstrating the expected anabolic-dominant profile. Serum calcium and renal function remained stable. Two new vertebral fractures occurred during treatment; no non-vertebral fractures or treatment-limiting adverse biochemical changes were identified.

Conclusion: In this real-world NHS cohort, romosozumab produced clinically meaningful improvements in spine and hip BMD, with favourable bone turnover responses and low short-term fracture incidence. These data support its effectiveness and tolerability in routine UK practice and contribute to the emerging national evidence base on its early implementation following NICE approval. Larger multicenter datasets are needed to establish long-term outcomes and optimise patient selection pathways.