The introduction of the bone-forming agent romosozumab has led to a dramatic improvement in osteoporosis treatment. While bisphosphonates remain the most commonly used drugs for the treatment of osteoporosis, it is recommended that patients at high risk of fractures initially receive bone-forming agents, followed by sequential treatment with bone resorption inhibitors. Romosozumab, an anti-sclerostin antibody, is an osteoporosis medication with both bone formation-stimulating and bone resorption-inhibiting properties, demonstrating significant efficacy in increasing bone mineral density and reducing fracture risk. However, due to the limited 12-month initial treatment period, sequential therapy with other osteoporosis medications is necessary following the completion of romosozumab administration. Due to the current lack of sufficient evidence regarding the use of romosozumab in sequential and combination therapies, this review aims to evaluate the efficacy of romosozumab as a sequential treatment, its effectiveness in combination with other agents, and its role in reducing new fragility fractures and increasing bone mineral density following sequential therapy after romosozumab. This review will summarize clinical trials and real-world data, providing valuable information to guide treatment decisions.
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