Sequential Osteoporosis Therapy — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMetabolic Bone DiseaseSequential Osteoporosis TherapySCE Rheumatology

A 50-year-old postmenopausal woman with severe osteoporosis and multiple vertebral fragility fractures has completed a planned 24-month course of teriparatide. She remains at high fracture risk and has no contraindication to standard antiresorptive treatment. Which is the most appropriate next pharmacological strategy to preserve the skeletal benefit achieved?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Start a bisphosphonate or denosumab

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · E = shown as D · C = shown as E

B is correct. After completing finite anabolic therapy with teriparatide, an antiresorptive agent should be started to maintain the increase in bone mineral density and provide continuing fracture protection; NICE describes this sequence as standard UK clinical management. Appropriate options include an oral or intravenous bisphosphonate or denosumab, selected according to renal function, contraindications, adherence and the long-term treatment plan. A treatment-free interval or calcium and vitamin D alone would not consolidate the anabolic response — bone density gains are rapidly lost without antiresorptive follow-on, and supplements are adjuncts rather than definitive therapy. The UK SmPC states that the lifetime 24-month teriparatide course should not be repeated, excluding E. Romosozumab is another bone-forming agent and is not the standard UK consolidation strategy after teriparatide.

Reference: NICE. Abaloparatide for treating osteoporosis after menopause (TA991), section 3: Committee discussion — clinical management. 2024. https://www.nice.org.uk/guidance/ta991/chapter/3-Committee-discussion