Inclusion Criteria:  Postmenopausal women at high risk of fracture  Exclusion Criteria:  Prior therapy exclusions  current use or use in the past 12 months of oral bisphosphonates or denosumab current use or use within the past 3 months of estrogens, selective estrogen receptor modulators, or calcitonin. use of oral or parenteral glucocorticoids for more than 14 days within the past 6 months any current or previous use of romosozumab, strontium, teriparatide, abaloparatide, or any parenteral bisphosphonate.  Other exclusions  Confirmed serum alkaline greater than 2 times the upper normal limit). Stage 4 or 5 chronic kidney disease (GFR less than 30) Hypercalcemia (Calcium greater than 10.5 mg/dL) Hypocalcemia (Calcium less than 8.8 mg/dL) Elevated blood parathyroid hormone (PTH) (intact PTH greater than 65 pg/ml) Serum 25-hydroxy vitamin D less than 20 ng/ml Hematocrit less than 32%. History of malignancy (except basal cell carcinoma). Significant pulmonary disease History of myocardial infarction or stroke within the preceding year. History of unstable angina or transient ischemic attack in the past year. Current atrial fibrillation. Any health condition that, in the opinion of the study physician, significantly increases the risk of cardiovascular events. Major psychiatric disease that in the opinion of the investigator would preclude the subject from providing adequate informed consent or completing the protocol procedures. Excessive alcohol use or substance abuse that in the opinion of the investigator would preclude the subject from providing adequate informed consent or completing the protocol procedures. Uncontrolled eczema Congenital or acquired bone disease other than osteoporosis Known sensitivity to denosumab or any of its excipients. Known sensitivity to romosozumab or any of its excipients.