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Osteoporosis — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseOsteoporosisSCE Rheumatology

A 65-year-old woman has taken oral alendronate for 5 years for postmenopausal osteoporosis with good adherence. She has never sustained a fragility fracture, has not received systemic glucocorticoids and has no other major clinical risk factors for fracture. Repeat DXA shows a total-hip T-score of −2.0. What is the most appropriate management?

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Correct answer: E — Pause alendronate and reassess fracture risk in 2 years

The correct answer is E. Oral bisphosphonate treatment should be reviewed after 5 years. This woman is not in a group for whom longer treatment is usually recommended: she is younger than 70 years, has no previous or on-treatment fracture, is not taking glucocorticoids and has a hip T-score above −2.5. A treatment pause is therefore appropriate, with fracture-risk reassessment after 2 years for alendronate, or sooner if she sustains a fracture. Alendronate remains within bone and has a residual antiresorptive effect after withdrawal. Teriparatide is generally reserved for very high fracture risk, and there is no indication to escalate to denosumab. Treatment should not be stopped permanently because risk can increase during the pause. Indefinite unreviewed therapy is also inappropriate because benefits and rare long-term harms must be reassessed.

Reference: National Osteoporosis Guideline Group. The 2024 UK clinical guideline for the prevention and treatment of osteoporosis—section on duration and monitoring of bisphosphonate treatment. Published 2025. https://pubmed.ncbi.nlm.nih.gov/40921943/