Guidelines have changed. Managing osteoporosis in General Practice 

Osteoporosis-related fractures cost around $3.5 billion in 2023 and are estimated to increase to $4.9 billion per year by 2033. That’s a 38% increase over a 10-year period (here). For patients at very high fracture risk, choosing to treat with a bone anabolic prior to antiresorptive therapy rapidly and significantly reduces this risk of fracture and contributes to improved outcomes in bone health (here, here, here).
 
The treatment paradigm has changed
 
Historically, antiresorptive therapies have been the mainstay of treatment for all patients regardless of fracture risk (here, here). This paradigm has now changed. Treating osteoporosis should involve a risk-stratification approach to ensure that patients at very high fracture risk can be considered for initial treatment with a bone anabolic (here, here).

There is a short window of opportunity to optimise patient outcomes with bone anabolics: Choosing to initiate antiresorptive therapy before assessing fracture risk may preclude your very high fracture risk patient from receiving optimal first line treatment with a bone anabolic(here, here, here). Instead, these patients should be referred to a bone specialist who plays a critical role in confirming very high fracture risk status and initiating a bone anabolic where appropriate (here, here).
Bone anabolics work differently to antiresorptive therapies
 
Compared with traditional antiresorptive therapies, which work to slow bone loss, the bone anabolic romosozumab has a unique dual mode of action that builds new bone AND slows bone loss (Box 2) (here, here, here, here).

Box 2: Summary of osteoporosis treatments (here, here, here)

Osteoporosis treatment sequence matters. Bone anabolics are recommended as 1^st line treatment before antiresorptive therapy in very high risk patients
 
Osteoporosis is a chronic disease that requires lifelong treatment in most patients (here) and as such, sequential therapies are recommended to optimise bone health and reduce fractures across your patient’s lifespan (here). Initial therapy should be selected based on the probability of achieving treatment targets within a reasonable timeframe, especially for patients at very high fracture risk (here).
 
The evidence is clear – osteoporosis treatment sequence matters (here). By referring your patients for romosozumab before starting them on an antiresorptive, you can build bone rapidly first with romosozumab and maintain gains with an antiresorptive (here, here, here). A summary of two head-to-head clinical trials assessing the efficacy and safety of romosozumab is provided in Box 3.

Key steps for GPs when managing osteoporosis
 
Pause: Bone anabolics, including EVENITY, are recommended as first line treatment for patients at very high fracture risk(here, here, here, here).

Assess: Before initiating osteoporosis treatment, assess if very high fracture risk indicators are present(here, here).

Refer: RACGP/HBA guidelines recommend considering referral to a bone specialist for a bone anabolic for those at very high fracture risk (here, here).

“romosozumab for first-line use in very high-risk patients, a paradigm shift in the treatment of osteoporosis is now applicable, ultimately offering better health outcomes for our patients.”

-Jasna Aleksova and Peter Ebeling. Read the complete article (here)

TGA indication: treatment of osteoporosis in postmenopausal women at high risk of fracture and to increase bone mass in men with osteoporosis at high risk of fracture(here).

Refer to full Product Information before prescribing; available from Amgen Australia Pty Ltd, Ph: 1800 803 638 or at www.amgen.com.au/Evenity.PI.
 
For more information on EVENITY or to report an adverse event or product complaint involving romosozumab, please contact Amgen Medical Information on 1800 803 638 or visit www.amgenmedinfo.com.au.
 
^{▼ This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at www.tga.gov.au/reporting-problems.
 
EVENITY MINIMUM PRODUCT INFORMATION. INDICATIONS: Treatment of osteoporosis in postmenopausal women at high risk of fracture. Treatment to increase bone mass in men with osteoporosis at high risk of fracture. CONTRAINDICATIONS: Uncorrected hypocalcaemia. Hypersensitivity to romosozumab, CHO-derived proteins or any component. History of myocardial infarction (MI) or stroke. PRECAUTIONS: Assess cardiovascular risk factors (e.g. established cardiovascular disease, hypertension, hyperlipidaemia, diabetes mellitus, smoking, severe renal impairment, age) prior to treatment. A patient’s suitability for treatment should be based on individual benefit-risk assessment. Consider relative benefits and risks of treatment in patients at high cardiovascular risk. Instruct patients to watch for symptoms of MI and stroke and to seek prompt medical attention if symptoms occur. Discontinue use if MI or stroke occurs during therapy. Correct hypocalcaemia prior to initiating therapy. Monitor patients for signs and symptoms. Adequately supplement intake of calcium and vitamin D. Initiate appropriate therapy and discontinue use if anaphylactic or other clinically significant allergic reaction occurs. Evaluate patients for risk factors for osteonecrosis of the jaw (ONJ); use with caution in these patients. Consider discontinuation if ONJ occurs. Rare reports of atypical femoral fractures. ADVERSE EFFECTS: Very Common: viral upper respiratory tract infection and arthralgia. Common: hypersensitivity, rash, dermatitis, headache, cough, neck pain, muscle spasms, peripheral edema and injection site reactions. DOSAGE AND ADMINISTRATION: Subcutaneous injection of 210 mg, once every month for 12 doses. To administer 210 mg, give two subcutaneous injections. Ensure adequate intake of calcium and vitamin D. After completing therapy, transition to antiresorptive osteoporosis therapy. No dose adjustment required in the elderly or in renal impairment. PRESENTATION: Pre-filled syringe, supplied as a 2-pack. Minimum PI Version 3. Refer to full Product Information before prescribing – available from Amgen Australia Pty Ltd. Ph: 1800 803 638 or at www.amgen.com.au/Evenity.PI
 
Abbreviations: AE, adverse events; ARR, absolute risk reduction; BMD, bone mineral density; BMI, body mass index; FRAX, fracture risk assessment tool; GP, general practitioner; HBA, Healthy Bones Australia; PBS, Pharmaceutical Benefits Scheme; RACGP, Royal Australian College of General Practitioners; RRR, relative risk reduction; TGA, Therapeutic Goods Administration; TRAE, treatment-related adverse event.
 
 
EVENITY is a registered trademark of Amgen Australia Pty Ltd. ABN 31 051 057 428, Sydney NSW 2000. ©2026 Amgen Inc. All rights reserved. AUS-785-26-80016. Approved March 2026.}