Background <p>Dialysis patients are at increased risk of fractures, particularly in the proximal femur where cortical bone predominates. Effective treatments targeting cortical bone are therefore essential.</p> Summary <p>Romosozumab is a monoclonal antibody that simultaneously promotes bone formation and inhibits bone resorption. It is administered monthly in a clinical setting and continued for one year, offering a treatment regimen acceptable to patients. In dialysis patients, romosozumab has been shown to significantly increase bone mineral density not only in the lumbar spine but also in the proximal femur and femoral neck. However, since dialysis patients are at higher risk of cardiovascular events, the risks and benefits of romosozumab require careful consideration.</p> Key Messages <p>Romosozumab effectively improves both trabecular and cortical bone mass in dialysis patients.</p> <p>Cardiovascular safety concerns necessitate cautious patient selection.</p> <p>Romosozumab offers medical and economic advantages over teriparatide.</p>