Osteoporosis is a metabolic bone disease characterized by increased risk of fractures. Bisphosphonates and denosumab are widely used in the pharmacotherapy of osteoporosis. In severe cases, anabolic drugs and romosozumab (ROMO) – a monoclonal antibody that acts bi-modularly, blocking the sclerotin pathway, leading to bone formation and reduced bone resorption – are used. The paper presents data from one of the first post-trial ROMO therapies in Poland under real-data follow-up. The research paper presents a 61-year-old woman with severe postmenopausal osteoporosis and multiple osteoporotic fractures (MOF) of the thoracic and lumbar vertebrae after 5 times of vertebroplasty. The patient underwent a full differential diagnosis because of a suspected secondary cause of the disease, which was ruled out. Because of the patient's contraindication to bisphosphonates and very high fracture risk, denosumab was used in the treatment. Due to a decrease in bone mineral density (BMD) in the follow-up, dual-energy X-ray absorptiometry (DXA) and treatment with ROMO was started (Mar 2024). The treatment was well tolerated. No early adverse effects were observed. Due to its strong antifracture efficacy and the bi-modal mechanism of the latest guidelines for the diagnosis and management of osteoporosis in Poland, ROMO was recommend. This could be the first-line treatment in postmenopausal women at very high risk of fracture.