PO:20:003 | Romosozumab effect on neutrophil-to-lymphocyte ratio in post-menopausal women at high risk of fracture
Giorgia Scagliosi1, Mariana Diaz Lopez1, Martina Teoni1, Francesco Pollastri1, Anna Piccinelli1, Camilla Benini1, Valeria Messina1, Emma Pasetto1, Davide Gatti1, Ombretta Viapiana1, Maurizio Rossini1, Giovanni Adami1. | 1Università di Verona, Dipartimento di Medicina, Verona, Italy; 2Università di Verona, Dipartimento di Medicina, Verona, Italy; 3Università di Verona, Dipartimento di Medicina, Verona, Italy; 4Università di Verona, Dipartimento di Medicina, Verona, Italy; 5Università di Verona, Dipartimento di Medicina, Verona, Italy; 6Università di Verona, Dipartimento di Medicina, Verona, Italy; 7Università di Verona, Dipartimento di Medicina, Verona, Italy; 8Università di Verona, Dipartimento di Medicina, Verona, Italy; 9Università di Verona, Dipartimento di Medicina, Verona, Italy; 10Università di Verona, Dipartimento di Medicina, Verona, Italy; 11Università di Verona, Dipartimento di Medicina, Verona, Italy; 12Università di Verona, Dipartimento di Medicina, Verona, Italy.
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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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