I agree. It is very effective as first-line therapy in patients at high risk for fracture. It can also be useful post bisphosphonate therapy. I have used it successfully multiple times to transition patients from long-term Prolia therapy without loss of bone mass.

It is ideal to give romo as initial therapy for high risk patients but it is also useful when given after BP.

First line for severe if covered by insurance and patient not keen on daily injections. 2nd line after bisphosphonates otherwise.

Agree with above.