Endocrine Abstracts

Introduction: The current UK guidelines (NICE TA791) recommend the use of romosozumab, a monoclonal sclerostin inhibitor, for patients at high imminent risk of fragility fractures. However, elderly patients with a very high risk of fractures often exhibit frailty and other comorbidities. This retrospective survey was conducted in a major trauma centre in northern England to evaluate the potential utilisation of romosozumab in a real-world setting.

Methods: The study included patients admitted with femoral (neck, intertrochanteric, subtrochanteric, subcapital) and vertebral fragility fractures over six months from January 2022. The patients were identified from coding by the BI analytics team. DXA scans, electronic records and linked GP records were reviewed. Male and paediatric patients, atypical and high-impact trauma fractures, patients outside the local geographical area, death before discharge, or with insufficient clinical details were excluded.

Results: After exclusions, a total of 244 subjects (avg. age 84) were identified. Among them, 81 (33.19%) met the romosozumab criteria as outlined in the NOGG consensus advisory statement. The reasons for ineligibility are provided in the table below. 58 (72%) of the individuals meeting the criteria had not received DXA scans at the time of the survey.

Discussion: No age cut-off exists for romosozumab use but frailty and CVD were key factors influencing suitability. Given DXA is necessary to identify suitable patients, it is crucial to invest in staff to effectively identify and prioritise eligible patients. Prior bisphosphonate use does not exclude romosozumab use but initiating alternative treatments may be considered for treatment-naïve patients with delayed DXA and clinic review. Many fragility fracture patients could benefit from romosozumab, but significant changes in pathways and services are needed.