When can Evenity (romosozumab) be started after a fracture has healed?

When to Start Evenity (Romosozumab) After a Fracture

Romosozumab (Evenity) can be started after fracture healing is complete, with evidence supporting its use particularly in patients with recent fractures (within the past 12-24 months) who are at high risk for subsequent fractures.

Timing of Romosozumab Initiation After Fracture

• Romosozumab should be initiated after the fracture has healed, as successful surgical outcomes depend on the bone's capacity to remodel and heal through callus formation 1
• For patients with recent fractures (within the past 12-24 months), romosozumab represents an ideal first-line treatment option due to its dual mechanism of action that increases bone formation while decreasing bone resorption 2
• Romosozumab is particularly beneficial for patients with osteoporotic fractures who are at very high risk for subsequent fractures 1, 2

Evidence Supporting Post-Fracture Use

• In clinical trials, romosozumab demonstrated significant improvement in fracture healing compared to placebo, with 43.1% of fractures fully healed at 24 weeks with romosozumab versus only 7.7% with placebo 1
• By 48 weeks of treatment, the healing rate of baseline fractures or pseudofractures reached 63.1% in patients receiving continuous romosozumab 1
• Romosozumab showed an 82% reduction in the risk of clinical vertebral fractures at 12 months compared to placebo 1

Specific Recommendations for Different Fracture Types

• For vertebral compression fractures: Romosozumab can be initiated after the acute pain phase has resolved and the fracture shows signs of healing, typically 6-12 weeks after the fracture event 3, 4
• For non-vertebral fractures: Initiation should occur after radiographic evidence of fracture healing, which typically takes 2-3 months depending on the fracture site 1
• For patients with pseudofractures: Romosozumab has shown superior healing compared to conventional therapy and can be initiated once the acute phase has passed 1

Treatment Sequence Considerations

• For patients with very high fracture risk (recent major fracture within two years), romosozumab is ideally used as first-line treatment 2
• The sequential use of romosozumab followed by an antiresorptive agent (like alendronate) provides superior fracture risk reduction compared to antiresorptive therapy alone 1
• In females with high fracture risk due to age and fracture history, sequential romosozumab followed by alendronate reduced hip fracture risk by 38% over 24 months compared to alendronate alone 1

Important Clinical Considerations

• Romosozumab is contraindicated in patients with hypocalcemia or a personal history of stroke or myocardial infarction 2
• Treatment duration with romosozumab is limited to 12 months, after which patients should transition to an antiresorptive agent to maintain bone density gains 5
• Continued monitoring is essential as the beneficial effects of romosozumab appear to be limited to the time of continuous treatment 1

Practical Approach to Timing

1. Confirm fracture healing through clinical assessment and radiographic evidence 1
2. Assess patient's fracture risk profile to determine if they meet criteria for high or very high fracture risk 1
3. For patients with recent major fractures (within 2 years), consider romosozumab as first-line therapy once healing is established 2
4. Plan for 12 months of romosozumab therapy followed by transition to an antiresorptive agent 5