What is the classification and reasonable next step for a patient with a T-score of -2.7 and a history of fractures?

The classification of the patient's bone density with a T-score of -2.7 indicates severe osteoporosis, as a T-score of -2.5 or lower is necessary for this diagnosis. The presence of a history of fractures further supports the classification of severe osteoporosis, as this condition significantly increases the risk of additional fractures.

In terms of management, romosozumab is a monoclonal antibody that stimulates bone formation and decreases bone resorption, which makes it a compelling treatment option for patients with severe osteoporosis who are at high risk of fractures. Given this patient's circumstances, switching to romosozumab would be a reasonable step to help improve their bone density and reduce fracture risk.

Other options may suggest less suitable interventions, such as maintaining vitamin D and calcium supplementation without addressing the severe nature of the osteoporosis, or considering medications that may not provide the most effective change in treatment for someone with severe disease. Therefore, the selection of romosozumab aligns well with the patient's severe osteoporosis status and history of fractures, making it the most appropriate next step.