Considerations regarding the use of romosozumab in a patient at high risk for cardiovascular disease

Treatment decisions are being made for a 74 year-old woman with multiple and recent vertebral fractures. Romosozumab therapy is considered because of superior efficacy compared to other osteoporosis therapies. However, because of her age, well controlled hypertension and mild hyperlipidemia, she is, according to a risk calculator, at high risk for cardiovascular (CV) disease. Romosozumab is contraindicated for patients at very high risk of CV disease, and clinicians are advised to consider the skeletal benefits vs potential CV risks in patients with CV risk factors. The background information leading to that contraindication and recent real-world evidence about the relationship between romosozumab and CV risk is reviewed to aid in the discussion with the patient and her primary care provider.