Sclerostin, a glycoprotein produced primarily by osteocytes, blocks the 
canonical Wnt signaling bone formation pathway. Romosozumab is a humanized 
monoclonal antibody to sclerostin that binds to sclerostin, permitting the 
engagement of Wnt ligands with their co-receptors, resulting in an increase in 
bone formation and bone mineral density (BMD). Clinical studies with romosozumab 
have shown dramatic improvements in BMD at the spine and hip. Romosozumab is 
associated with improvement in bone strength through mechanisms that include 
increases in bone formation and, different from classical osteoanabolic agents, 
suppression of bone resorption. Areas covered: Herein, the authors highlight the 
available data on romosozumab for the treatment of osteoporosis. This includes 
the latest data on the efficacy, pharmacokinetics and pharmacodynamics as well 
as safety and tolerability data. Expert opinion: Monthly subcutaneous dosing of 
romosozumab reduces the risk of vertebral and clinical fractures in women with 
postmenopausal osteoporosis, with a favorable balance of benefits and risks. 
Romosozumab is a promising emerging anabolic agent with a novel mechanism of 
action that may expand the options for treating osteoporotic patients at high 
risk of fracture.