Frankly, knowing the data fairly well, I think the decision is a matter of style. Recall that the enhanced cardiovascular risk was only seen in the ARCH trial when romosozumab was compared to alendronate (leaving open the interpretation that alendronate reduces CV events, rather than romo increasing...

I think the cardiovascular safety data is complex. I have reviewed the data and have heard several good presentations at bone meetings. I am of the opinion that if someone has had an event such as an MI even more than two years ago, I would likely not prescribe romosozumab. We have two other anaboli...

I would use Romosozumab if my patients had severe Osteoporosis and could not tolerate Denosumab or teriperatide

Alendronate has protective roles against cardiovascular complications of romosozumab. Even this combination may reduce cardiovascular events. I would recommend using romosozumab + alendronate to improve bone and cardiovascular conditions. Asadipooya & Weinstock, PMID 31242037