Endocrine Abstracts

Introduction: Romosozumab is approved for the treatment of post-menopausal osteoporosis with very high fracture risk and recent fragility fracture (1). Timely assessment and treatment prevent morbidity. The National Osteoporosis Guideline Group (NOGG) recommends a Fracture Liaison Service (FLS) to identify potential candidates (2). This study evaluates identification of Romosozumab candidates via an expedited FLS referral pathway at a UK teaching hospital.

Methods: All post-menopausal female referrals between December 2023 and April 2024 were reviewed. Standardised data were collected including demographics, fracture site, treatment, cardiovascular history, NOGG and fracture risks. Eligibility for Romosozumab was assessed against local criteria, based on NICE and NOGG guidelines. Classification data analysis assessed alignment of referrals with local criteria.

Results: 257 patients were included, mean age 80.1years (range 50-97). 87% were not on osteoporosis treatment at referral. 68% had a very high-risk FRAX score. 56% of referrals were accurate. 43% were referred as eligible for Romosozumab but 8% were actually eligible. The main reasons for non-eligibility were cardiovascular risk and clinical frailty. 20 patients from the cohort were true Romosozumab candidates, of whom 45% were correctly identified at referral.

Conclusions: Most patients referred via FLS were classed as very high risk and deemed potential candidates for Romosozumab. However, only a minority were eligible based on NICE/NOGG criteria. Over half of suitable patients were not appropriately identified. These inaccuracies may result in under-identification of eligible patients and impede the expedited pathway. Targeted clinician education and improved referral processes may enhance identification of women at very high fracture risk and enable timely intervention.

References: 1. Thorley J. NICE approves romosozumab for postmenopausal osteoporosis. Lancet Rheumatol [Internet]. 2022 Aug 1;4(8):e532. Available from: https://doi.org/10.1016/S2665-9913(22)00188-6. 2. National Osteoporosis Guideline Group. Clinical guideline for the prevention and treatment of osteoporosis. 2024;(December):1–74. Available from: www.nogg.org.uk