Practice question

A 59-year-old woman with obesity and long-standing type 2 diabetes complains of bone pain and height loss. DXA scan shows T-score -2.7 at the femoral neck. She has no history of fragility fractures and eGFR is 70 mL/min/1.73 m². According to osteoporosis guidelines, which pharmacological treatment is most appropriate as first-line?