Romosozumab (Evenity)

Romosozumab is a biologic medicine used to treat osteoporosis, a condition where bones become weaker and are more likely to break (fracture). It is an antibody treatment that blocks a molecule called sclerostin. Sclerostin normally inhibits or decreases bone formation. By inhibiting sclerostin, romosozumab increases bone formation and improves bone strength.

It is approved for use in post-menopausal women with a high risk of fracture who can’t take other osteoporosis treatments.

How to Take It

Romosozumab is given as an injection under the skin, usually by your rheumatologist or nursing staff. The usual dose is 210 mg once a month, given as two separate 105 mg injections, one after the other. People on romosozumab should take adequate calcium (1,000–1,200 mg) and vitamin D (at least 400 IU) every day but should review these doses with their prescribing healthcare provider before starting treatment.

Romosozumab works quickly—within 2 weeks of an injection, the effects can be detected in the blood; this medicine also stays in the blood for several months after each dose.

Blood and bone density tests should be done before starting treatment, a dental exam is also recommended.

Side Effects

Romosozumab may increase the risk of heart attack, stroke, and death from heart disease and should not be used if people who have had a heart attack or stroke in the past year.

The most common side effects that patients experience include joint pain (reported in 8–13% of people or about 1 in 10 people in clinical trials for this medication), headache (5–7% or about 1 in 20 people taking this medication), and pain or irritation at the injection site (about 1 in 20 people).

Romosozumab can cause hypocalcemia (low calcium levels in the blood).

Rare but serious side effects (happened in less than 1 in 100 people on this medication) can include unusual stress fractures of the thigh bone (atypical femur fractures), damage to the jaw bone (osteonecrosis of the jaw), and severe allergic reactions including skin rashes or hives, low blood pressure, throat and tongue swelling, and difficulty breathing.

Tell Your Rheumatology Provider

Before starting this medication tell your provider if you have had a recent heart attack or stroke, if you have low blood calcium levels; if you are planning to have dental surgery or teeth removed; if you are pregnant, considering pregnancy, or are breastfeeding.

Romosozumab has not been studied in people who could become pregnant, its use is not recommended in patients in this group.

Notify your rheumatology provider if you have the following symptoms while taking this medication: chest pain, shortness of breath, headaches, changes in vision, feeling lightheaded, difficulty talking, numbness or tingling of the hands or around the mouth, new pain in the jaw, or fevers or other signs of infection.

Updated March 2024 by Elizabeth Graef, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.