Identifying Post-Menopausal Inpatients Eligible for Romosozumab Treatment at Leeds Teaching Hospitals

Introduction:

1 in 2 women over the age of 50 will have an osteoporotic fracture in their lifetime. Romosozumab is approved for the treatment of post-menopausal osteoporosis with very high fracture risk and recent fragility fracture (1). At Leeds Teaching Hospital Trust (LTHT), patients are referred to the Fracture Liaison Service (FLS) via an electronic referral form. One key question on the form is whether the patient might be suitable for anabolic agents, such as Romosozumab. If marked as ‘yes’, the referral is fast-tracked for a quick clinic assessment. This study evaluates identification of Romosozumab candidates via an expedited FLS referral pathway at LTHT.​

 

Methodology:

All post-menopausal women referred to the FLS between December 2023 and April 2024 were included, excluding those with incomplete data. Data was collected via a standardised proforma to evaluate eligibility and referral accuracy. Eligibility for Romosozumab was assessed against local guidelines, based on NICE and NOGG guidelines (2). ​Classification data analysis was used to assess the alignment of referrals with the LTHT guidelines.

 

Results:

Of the 257 referrals analysed 111 were referred as suitable and 146 were referred as unsuitable for Romosozumab. According to LTHT’s pathway, 20 of the 257 patients were suitable and 237 were unsuitable. Referral accuracy was 56.1%, recall was 45%, and precision was 8.1%. Of the 5 patients started on Romosozumab, 3 were referred as suitable.

 

Conclusion:

These findings demonstrate discrepancies between clinician referrals and Romosozumab suitability. The majority of patients referred as suitable for Romosozumab were not suitable according to LTHT's pathway. ​Over-identification of suitability may strain FLS resources and impede a fast-track pathway, while under-identification risks missed treatment opportunities . ​Possible reasons include low awareness among resident doctors and an unclear referral form. A planned quality improvement project will focus on these issues with the aim of improving identification of high-risk women and improve their bone health.