Abstract
Romosumab (ROMO) should be used to treat postmenopausal women with osteoporosis at high fracture risk after carefully considering the cardiovascular status and the risk/benefit balance. Clinicians should avoid ROMO for patients with a history of myocardial infarction or stroke in the past 12 months. Although ROMO offers an alternative for patients with a high risk of osteoporotic fractures, it is affected by previous osteoporosis treatment: using denosumab (DENO) and oral bisphosphonates for over one year attenuates its effect. An additional 12 months of DENO appears to be more effective than ibandronate for the enhancement of bone mineral density (BMD) as a sequential agent after 12 months of ROMO, with few severe adverse events. However, it is important to emphasize that ROMO is not a first-choice medication. It is only indicated when bisphosphonates cannot help, and its clinical use has demonstrated cardiovascular risks. The cost and availability could also make its use problematic in clinical practice. Therefore, although ROMO represents an important advance in the treatment of osteoporosis, it is by no means a solution for osteoporosis.
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