Potential Suitability Of Hip Fracture Patients for Romosozumab Therapy: A Retrospective Review

Abstract Background Romosozumab is a dual acting antiresorptive and anabolic agent used for severe postmenopausal osteoporosis. Eligibility criteria includes T score ≤ -2.5 at hip, spine or distal forearm (if hip and spine not available) and fracture of humerus, distal radius, hip or vertebrae in the last 24 months. Romosozuamb is recommended as a first line therapy in patients at very high fracture risk. However, contraindications include previous MI or stroke and there is caution with use when significant cardiovascular risk factors. We aimed to identify hip fracture patients at our hospital who might be suitable for romosozumab. Methods Retrospective review of female patients admitted with a hip fracture at our hospital over a one year period. Information on demographics and medical history was collated: myocardial infarction (MI), stroke, ischaemic heart disease (IHD), peripheral arterial disease (PAD), heart failure, atrial fibrillation (AF), diabetes and current smokers. Data on DXA derived T scores in a subset was also recorded. Results 133 patients, mean age 82.8 ± 7.7 years. 8.2% had a history of MI or stroke, 16.5% IHD, 13.5% AF, 10.5% HF and 6.0% PAD. Diabetes was found in 9.0% and 6.7% were current smokers. Overall, 45% had an MI or stroke history and/or any of above the risk factors. In a subset with BMD assessment (n=68), 55.8% had T scores < 2.5 and of them 63.1% had none of the above risk factors. Overall, 35.2% of this sample had none of the above risk factors and T scores < -2.5. Conclusion Nearly 10% had absolute contraindications to therapy, though nearly half had significant cardiovascular risk factors. While the sample with DXA results was small, results suggest that up to one third might potentially be suitable for therapy. However, other factors such as physical frailty, and cognitive impairment are also likely to preclude its use.