Romosozumab
Sclerostin inhibitors
Sclerostin inhibitors
A monthly antibody injection that blocks sclerostin. It builds bone fast in postmenopausal women at very high fracture risk.
Also called: Romosozumab-aqqg
Quick facts
- Group
- Sclerostin inhibitors
- Target
- Sclerostin (SOST)
- Used for
- Osteoporosis
- Key effects
- Joint pain · Pain and redness at the injection site
- Monitor
- Serum calcium before starting · Dental health before
- ATC
- M05BX06
No doses: the clinician sets them by the current guideline.
Mechanism of action
Romosozumab is a humanised monoclonal antibody that binds sclerostin, a protein released by osteocytes that inhibits Wnt signalling in osteoblasts. With sclerostin neutralised, osteoblasts form more bone and bone resorption decreases. Bone mineral density rises quickly; after the course an antiresorptive drug is started so that the gain is kept.
- Romosozumab binds and neutralises sclerostin
- Wnt signalling in osteoblasts is released
- Bone formation rises and resorption falls
- Bone density increases and fractures decrease
Indications
- Osteoporosis in postmenopausal women at high fracture risk, or when other treatments failed or were not tolerated Osteoporosis →
Adverse effects
Common
- Joint pain
- Pain and redness at the injection site
Contraindications
- Hypocalcaemia not yet corrected
- Recent heart attack or stroke (especially within the past year): generally avoided
- Hypersensitivity to romosozumab
Key interactions
- Denosumab or bisphosphonates
- Started after the romosozumab course to keep the bone gained
- Calcium and vitamin D
- Adequate intake is needed during treatment to avoid hypocalcaemia
What is monitored
- Serum calcium before starting
- Symptoms of heart attack or stroke
- Dental health before and during treatment
- Bone mineral density
Administration and safety
- Subcutaneous injection into the abdomen, upper arm or thigh by a health professional, monthly for a total of 12 doses
- Calcium is checked and low calcium corrected before the first dose
- A dental examination, and any needed dental treatment, comes before starting
Pregnancy and breastfeeding
It is approved only for postmenopausal women and is not used in pregnancy or breastfeeding.
Nursing care
- Ask about heart attack or stroke in the past year before each dose
- Teach the signs of heart attack and stroke and the need for emergency care
- Check calcium and encourage adequate calcium and vitamin D
- Advise a dental check before starting and good oral hygiene
Pharmacokinetics
- Absorption
- Given by subcutaneous injection once a month by a health professional
Test yourself
Think of the answer, then tap the question to see it.
What does romosozumab bind, and with what effect on bone?
Sclerostin; this releases Wnt signalling, so bone formation rises and bone resorption falls.
Which patients should not receive romosozumab because of its boxed warning?
People who had a heart attack or stroke within the past year, because it may raise the risk of cardiovascular events.
How long is the course and what comes after?
Twelve monthly doses, followed by an antiresorptive drug to maintain the gain in bone density.
Connections
← Back to the class: Sclerostin inhibitors
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 (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.