Osteoporosis — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseOsteoporosisSCE Rheumatology

A 72-year-old woman with a T-score of -3.2 at the lumbar spine has sustained a vertebral fracture. She has an eGFR of 28 mL/min. Which osteoporosis treatment is most appropriate?

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Correct answer: B — Denosumab

Denosumab (RANKL inhibitor) is the preferred treatment in severe CKD (eGFR <30 mL/min) as it is not renally cleared, unlike bisphosphonates which are contraindicated. However, hypocalcaemia risk is higher in CKD so calcium and vitamin D supplementation and monitoring are essential. Oral bisphosphonates are poorly absorbed and contraindicated in severe renal impairment. Teriparatide requires adequate renal function. NOGG guidelines support Denosumab as an option across all levels of renal function.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions