MON-801 Exploring a Potential Link Between Romosozumab and Retinal Vein Occlusion: A Case Study

Abstract Disclosure: M. Kurt Yaman: None. S. Lathief: None. M.S. Marangoz: None. Background: Romosozumab, a monoclonal antibody that inhibits sclerostin, is an anabolic agent approved for the treatment of severe osteoporosis in postmenopausal women at high fracture risk. By enhancing Wnt/β-catenin signaling, it increases bone formation but may also have vascular effects, including endothelial dysfunction and vascular calcification. (1) While the FRAME trial did not demonstrate increased cardiovascular risk, the ARCH trial reported a higher incidence of myocardial infarction and stroke. (2,3) Although branch retinal vein occlusion (BRVO) has not been previously reported in association with romosozumab, its potential to elevate blood pressure may increase retinal vascular risk. We report a case of BRVO incidentally detected following romosozumab initiation. Clinical Case A 75-year-old woman with well-controlled hypertension and macular degeneration was referred for osteoporosis management. A DEXA scan confirmed severe osteoporosis (left femoral neck T-score -3.5) with a FRAX-estimated 48% risk of major osteoporotic fracture. Laboratory evaluation was unremarkable for secondary causes of osteoporosis. Given her high fracture risk, monthly romosozumab 210 mg injections were initiated. Following the first dose, the patient reported increased blood pressure and knee pain. Three weeks later, a routine ophthalmology follow-up revealed a new BRVO on fundoscopic examination, which was not present in the prior year’s exam. She remained asymptomatic, with stable visual acuity. Blood pressure management was recommended by the ophthalmologist. After her second injection, she returned to the endocrinology clinic, where romosozumab was discontinued due to suspected vascular complications. Conclusion: This case highlights a potential association between romosozumab and retinal vein thrombosis, possibly mediated by its vascular effects. Romosozumab-induced endothelial dysfunction and increased arterial stiffness may contribute to hypertension, a known risk factor for BRVO. While clinical trials have primarily focused on cardiovascular risks, this case underscores the importance of monitoring for retinal vascular events in patients receiving romosozumab. Clinicians should consider ophthalmologic evaluation in patients with predisposing risk factors and visual changes. Further research is needed to clarify the vascular safety profile of romosozumab. References: 1) Asadipooya K, Weinstock A. Cardiovascular Outcomes of Romosozumab and Protective Role of Alendronate. Arterioscler Thromb Vasc Biol. 2019;39(7):1343-1350 2) Cosman F, Crittenden DB, Adachi JD, et al. Romosozumab Treatment in Postmenopausal Women with Osteoporosis. N Engl J Med. 2016;375(16):1532-1543 3) Saag KG, Petersen J, Brandi ML, et al. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. N Engl J Med. 2017;377(15):1417-1427 Presentation: Monday, July 14, 2025