Should Evenity Be Held During Foot Fracture Healing?
No, Evenity (romosozumab) should not be held during fracture healing—in fact, it should be continued or initiated after the acute fracture has healed, as it significantly accelerates fracture healing and reduces subsequent fracture risk in high-risk patients.
Rationale for Continuing Evenity
Fracture Healing Benefits
- Romosozumab demonstrates superior fracture healing outcomes, with 43.1% of fractures fully healed at 24 weeks compared to only 7.7% with placebo 1
- By 48 weeks of continuous treatment, the healing rate reaches 63.1% for baseline fractures or pseudofractures 1
- The dual mechanism of increasing bone formation while decreasing bone resorption makes romosozumab uniquely beneficial during the post-fracture period 2, 3
Timing Considerations
- For non-vertebral fractures (including foot fractures), initiate or continue romosozumab after radiographic evidence of fracture healing, which typically takes 2-3 months depending on the fracture site 1
- The medication works by inhibiting sclerostin, which increases modeling-based bone formation—this is precisely what is needed after the initial callus formation phase 2
- Successful surgical outcomes depend on the bone's capacity to remodel and heal through callus formation, so waiting for initial healing is prudent 1
Clinical Algorithm for Your Patient
Immediate Management (First 2-3 Months)
- Hold romosozumab only during the acute fracture healing phase (first 2-3 months post-injury) 1
- Ensure adequate calcium and vitamin D supplementation during this period 4
- Monitor fracture healing with serial radiographs
After Fracture Healing
- Resume or initiate romosozumab once radiographic evidence confirms fracture healing 1
- This patient is at very high risk for subsequent fractures, making romosozumab particularly beneficial 1, 5
- The 82% reduction in clinical vertebral fractures at 12 months makes continuation critical 1
Important Caveats
Sequential Therapy Requirement
- Romosozumab requires sequential anti-resorptive therapy after the 12-month treatment course to prevent rebound bone loss 4
- Discontinuation without sequential therapy leads to rapid bone loss and increased vertebral fracture risk 4
- Plan for transition to bisphosphonate or denosumab 6-7 months after the last romosozumab dose 4
Cardiovascular Considerations
- Romosozumab is contraindicated in patients with history of myocardial infarction or stroke 5, 6
- Screen for cardiovascular risk factors before resuming therapy 6
Monitoring During Treatment
- Correct any hypocalcemia before resuming romosozumab 5, 3
- Continue monitoring as beneficial effects are limited to the time of continuous treatment 1
The traumatic foot fracture from a car accident does not change the underlying osteoporosis indication for romosozumab—once the fracture shows radiographic healing (typically 2-3 months), resume therapy to maximize bone formation and prevent the next fracture.