Romosozumab (sold as Evenity) has a dual mechanism that sets it apart from all other osteoporosis medications. It simultaneously stimulates bone formation and inhibits bone resorption so building new bone while also slowing breakdown. No other approved osteoporosis medication does both at once.
In clinical trials, romosozumab produced significantly greater increases in bone density than bisphosphonates over the same period, particularly at the spine. For women with severe osteoporosis or a very high fracture risk, this dual action can produce meaningful gains in bone density within a single year of treatment.
CALLOUT: Evenity is not a first-line treatment for most women. It is typically reserved for those with severe osteoporosis, a very high fracture risk, multiple previous fractures, or those whose bones have not responded adequately to other treatments. If your doctor has recommended it, it is because your situation calls for a more aggressive approach.
What treatment involves
Romosozumab is given as two injections on the same day, once a month, for a maximum of twelve months. The injections are administered at a clinic or doctor's office so you do not self-inject at home.
The twelve-month treatment course is a hard limit. Unlike bisphosphonates or Prolia, romosozumab cannot be continued beyond one year. After completing the course, your doctor will transition you to an antiresorptive medication - typically a bisphosphonate or Prolia - to maintain the bone density gains achieved during treatment.
QUOTE: "Think of romosozumab as a building phase - a concentrated period of bone formation followed by a maintenance phase. The gains made during the year of treatment are preserved by what comes after it."
The cardiovascular consideration
Romosozumab carries an important cardiovascular warning that your doctor will have discussed with you but that deserves clear explanation here.
Clinical trials showed a small but statistically significant increase in cardiovascular events - heart attack and stroke - in women taking romosozumab compared to those taking alendronate. As a result, romosozumab is not recommended in women who have had a heart attack or stroke within the past year.
CALLOUT: If you have a history of heart disease or stroke, or significant cardiovascular risk factors, your doctor will weigh these carefully before recommending romosozumab. This is not a reason to refuse the medication without discussion but it is a conversation worth having explicitly.
Dental considerations
As with bisphosphonates and Prolia, ONJ is a rare but recognised risk. Inform your dentist before starting treatment, complete any significant dental work beforehand if possible, and maintain good dental hygiene throughout.
What to expect during treatment
Most women tolerate romosozumab well. The most common side effects are joint pain, back pain, and headache - generally mild. Injection site reactions are uncommon. Low calcium levels can occur, which is why calcium and vitamin D supplementation is important throughout treatment.
CALLOUT: A DEXA scan after completing the twelve-month course will show your doctor the full extent of the bone density gains achieved. That scan result is one of the most meaningful moments in your treatment journey. It’s a direct measure of what the medication has done for your bones.
After romosozumab - what comes next
The transition after completing romosozumab is not optional. Stopping without moving to a maintenance medication will result in rapid bone loss — reversing the gains made during treatment. Your doctor will plan the transition before your course ends, not after.
CALLOUT: If romosozumab has been recommended for you, the Medication Explainer in Lenari's medication guide covers what to expect — including the cardiovascular conversation to have with your doctor. [Read the Evenity guide →]