PO:20:003 | Romosozumab effect on neutrophil-to-lymphocyte ratio in post-menopausal women at high risk of fracture
Abstract
Background. Romosozumab (ROMO) is a monoclonal antibody targeting sclerostin (SOST), a key regulator of bone metabolism. It has been demonstrated that changes in SOST levels can affect distinct niches within the bone marrow that support hematopoiesis. To date, no clinical studies have explored the changes in complete blood count (CBC) parameters in patients receiving ROMO. The objective of of the present study was to investigate the effects of Romosozumab on CBC parameters in post-menopausal women at high risk of fracture.
Methods. We conducted a 12-month prospective observational study in post-menopausal women with severe osteoporosis treated with ROMO 210 mg/monthly during one year between October 2023 an April 2025. CBC values were assessed at baseline, 6 and 12 months. Inclusion criteria were: - Treatment with romosozumab as deemed necessary by the treating physician Exclusion criteria were: - Exposure to bisphosphonates within 12 months from romosozumab initiation - Prior treatment with other anti-osteoporosis medications - No diagnosis of anemia or lymphoma or leukemia - No active bleeding or recipients of plasma, red blood cells derivates and platelets in the last 12 months Absolute changes in CBC were assessed with a mixed model for repeated measures.
Results. A total of 113 post-menopausal women (mean age of 73.4±9.7 years) were included. Neutrophils levels slightly decreased over time, with a significant decrease at 6 months (p=0.022), that was not sustained at 12 months (p=0.500). Haemoglobin and lymphocytes levels showed no significant differences over the period of the study. In the overall trend across time points, there was a statistically significant decrease in the neutrophil-to-lymphocyte ratio (NLR) over the 12 months (2.0 ± 1.1 at baseline, 1.8 ± 1.1 at month 6, and 1.8 ± 1.2 at month 12; p=0.034), with a small effect size (Cohen’s = 0.22). Figure 1 shows the NLR over the 12 month study period.
Conclusion. In post-menopausal women with severe osteoporosis, 12 months of ROMO treatment was associated with a statistically significant reduction in NLR, reflecting a potential modulation of systemic inflammation, though the clinical relevance of this modest shift remains uncertain and warrants further investigation.
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