Osteonabolic agents most notably Romosuzumab not generally recommended as the first line for the treatment of osteoporosis, because of their substantial cost.Osteoanabolic treatment recommended in following individuals: (1) severe osteoporosis with high risk of fracture, (2) treatment failure with alternative osteoporosis agents with good adherent to treatment ( BMD loss or Fx), (3) contraindications or intolerance to other osteoporosis agents, and (4) GIOP..