Romosozumab (Evenity®) in Osteoporosis: When and Why It Is Used
Osteoporosis weakens the internal structure of bone, increasing the risk of fractures — particularly of the spine, hip and wrist. For many years, treatment focused primarily on slowing bone loss. More recently, newer therapies have become available that can actively build bone strength. One such treatment is romosozumab (Evenity®).
Romosozumab is not suitable for everyone, but for selected patients at very high fracture risk, it can play an important role in reducing the likelihood of further fractures and improving long-term bone health.
What Is Romosozumab and How Does It Work?
Romosozumab is a monoclonal antibody that targets sclerostin, a protein involved in regulating bone turnover. By inhibiting sclerostin, romosozumab has a dual action:
It stimulates new bone formation
It reduces bone resorption (bone breakdown)
This combination allows bone density and strength to increase more rapidly than with many traditional osteoporosis treatments.
Who Is Romosozumab Recommended For?
NICE Guidance
The National Institute for Health and Care Excellence (NICE) recommends romosozumab for:
Postmenopausal women with severe osteoporosis
Those at high fracture risk, particularly if they have sustained a major osteoporotic fracture (such as a vertebral or hip fracture) within the previous 24 months
Romosozumab is usually initiated under specialist supervision following careful clinical assessment.
NICE guidance:
https://www.nice.org.uk/guidance/ta791
NOGG and Royal Osteoporosis Society (ROS) Guidance
The National Osteoporosis Guideline Group (NOGG), supported by the Royal Osteoporosis Society (ROS), recognises romosozumab as an appropriate option for people at very high or imminent fracture risk.
Their guidance emphasises:
Careful patient selection
Use as part of a planned treatment sequence, typically followed by longer-term antiresorptive therapy to maintain bone gains
Further information:
https://www.nogg.org.uk
https://theros.org.uk
How Is Romosozumab Given?
Administered as a monthly injection under the skin
Given for a maximum of 12 months
After completion, most patients transition to another osteoporosis treatment (such as a bisphosphonate or denosumab) to preserve the improvement in bone strength
This sequential approach is an important part of guideline-based osteoporosis care.
What Are the Benefits?
Clinical studies have shown that romosozumab can:
Increase bone mineral density significantly
Reduce the risk of vertebral fractures
Reduce the risk of clinical fractures in patients at very high risk
For patients who have already sustained a recent fracture, improving bone strength quickly can be particularly important in reducing the chance of further injury.
Safety Considerations
Romosozumab is generally well tolerated, but careful assessment is essential.
Cardiovascular Risk
Romosozumab is not recommended for individuals who have had a heart attack or stroke within the previous year
Cardiovascular history is reviewed carefully before treatment is started
Calcium and Vitamin D
Low calcium levels must be corrected before starting treatment
Adequate vitamin D and calcium intake are important throughout therapy
Patients are monitored regularly to ensure treatment remains safe and appropriate.
Where Romosozumab Fits in Osteoporosis Care
Romosozumab is not a first-line treatment for many people with osteoporosis. It is reserved for situations where fracture risk is particularly high, or where other treatments are unsuitable or insufficient.
The aim is to:
Rapidly improve bone strength
Reduce near-term fracture risk
Follow with longer-term therapy to maintain benefit
This approach reflects current UK best practice and national guideline recommendations.
Why a Specialist Assessment Matters
Osteoporosis is rarely defined by bone density alone. Fracture history, rate of bone loss, inflammatory disease, steroid exposure, kidney function, cardiovascular risk and previous treatment response all influence which therapies are appropriate — and when.
A specialist assessment brings these factors together. In particular, newer treatments such as romosozumab require careful patient selection, thoughtful sequencing with other therapies, and a clear long-term plan beyond the initial 12-month course. This approach is shaped by experience managing complex bone disease within specialist and tertiary settings.
Patients often find it reassuring to:
Understand their individual fracture risk
Know why a specific treatment has been recommended
Feel confident their plan aligns with national guidance while being tailored to them
Have continuity and follow-up to monitor response over time
This whole-person, clinically led approach mirrors how osteoporosis is managed in specialist centres and helps ensure treatment decisions are both safe and effective.
Trusted Patient Information Resources
For patients wishing to read more, the following websites provide reliable, patient-friendly information:
Royal Osteoporosis Society – Romosozumab (Evenity®)
https://theros.org.uk/information-and-support/osteoporosis/treatment/romosozumab-evenity/NICE Guidance on Romosozumab
https://www.nice.org.uk/guidance/ta791National Osteoporosis Guideline Group (NOGG)
https://www.nogg.org.uk
In Summary
Romosozumab is a targeted osteoporosis treatment that builds bone and reduces bone loss
NICE, NOGG and the Royal Osteoporosis Society recommend it for postmenopausal women at very high fracture risk
It is given for 12 months, followed by longer-term osteoporosis therapy
Careful assessment, sequencing and monitoring are essential
When used appropriately, romosozumab can play an important role in reducing fracture risk and supporting long-term bone health.