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# Sclerostin inhibitors

Antibodies that remove the brake sclerostin puts on bone-building cells. Bone formation rises quickly and fractures fall.

Updated Nov 1, 2026

## What they are

Monoclonal antibodies against sclerostin, a protein made by osteocytes that inhibits bone formation. They treat severe osteoporosis in postmenopausal women at high fracture risk, for a fixed course, followed by an antiresorptive drug. Romosozumab is the member in use.

## Mechanism of action

Sclerostin blocks Wnt signalling in osteoblasts by binding the LRP5/6 co-receptors. Neutralising sclerostin releases Wnt signalling, so osteoblasts form more bone; at the same time bone resorption falls. The result is a rapid rise in bone mineral density (a dual effect, unlike PTH analogues, which also increase resorption).

Target: Sclerostin (SOST), an osteocyte protein that inhibits Wnt signalling

## Key points

- Dual action: more bone formation and less bone resorption.
- Boxed warning: heart attack, stroke and cardiovascular death; avoided after a recent heart attack or stroke.
- Given for a fixed course; then an antiresorptive drug keeps the gain.
- Shares the rare risks of potent bone drugs: osteonecrosis of the jaw and atypical femoral fracture; hypocalcaemia is corrected first.

## Drugs in this class

- [**Romosozumab** A monthly antibody injection that blocks sclerostin. It builds bone fast in postmenopausal women at very high fracture… Sclerostin (SOST)](https://durgical.com/en/pharmacology/romosozumab/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which signalling pathway does sclerostin inhibit?

The Wnt pathway in osteoblasts, by binding the LRP5/6 co-receptors; blocking sclerostin restores bone formation.

## What cardiovascular warning applies to romosozumab?

It may raise the risk of heart attack, stroke and cardiovascular death, so it is avoided after a recent heart attack or stroke.

## What usually follows a course of a sclerostin inhibitor?

An antiresorptive drug (such as denosumab or a bisphosphonate) to maintain the bone density gained.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Romosozumab-aqqg Injection: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a619026.html) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/sclerostin-inhibitors/