Romosozumab Treatment Duration and Sequential Therapy

Introduction to Romosozumab Treatment

• The American College of Physicians guidelines explicitly note that romosozumab use should be limited to 12 monthly doses because the anabolic effect wanes after this period 1, 2

Mandatory Sequential Therapy Requirement

• The American College of Rheumatology strongly recommends that romosozumab must be followed by sequential anti-resorptive therapy to prevent bone loss 3, 4, 5
• Discontinuation of romosozumab without sequential therapy leads to significant bone loss, similar to what occurs with PTH/PTHrP discontinuation 3, 4
• The guideline explicitly states that "ROM can be followed by DEN or BP" (denosumab or bisphosphonate) 3, 4

Recommended Sequential Therapy Options

• The American College of Rheumatology guidelines support either bisphosphonates or denosumab as appropriate sequential therapy after romosozumab 3, 4, 5

Safety and Monitoring Considerations

• The patient should continue adequate calcium and vitamin D supplementation during transition to anti-resorptive therapy 3