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Osteoporosis Not Cured by Treatment — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseOsteoporosis Not Cured by TreatmentSCE Rheumatology

A 70-year-old woman without a previous fragility fracture was diagnosed with osteoporosis when her lumbar-spine DXA T-score was -3.0. After 3 years of adherent alendronic acid treatment, her lumbar-spine T-score is -2.4. Which interpretation is most appropriate?

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Correct answer: E — Retain the osteoporosis diagnosis and reassess fracture risk before changing treatment

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

The osteoporosis diagnosis should be retained. Her original T-score of -3.0 established osteoporosis, and the rise to -2.4 represents a favourable treatment response rather than cure or erasure of the diagnosis. Fracture risk remains influenced by age, previous fractures, clinical risk factors and BMD. Decisions about continuing or pausing alendronic acid therefore require an individual fracture-risk and benefit-risk reassessment; they cannot be made from the improved lumbar-spine T-score alone. A previous fracture is not required to retain a diagnosis originally established by DXA, so A is incorrect. Options B and E incorrectly equate the current osteopenic-range value with loss of the osteoporosis diagnosis and mandate treatment withdrawal. Option D also incorrectly labels the condition as cured and prescribes a fixed duration without reassessment.

Reference: LeBoff MS et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporosis International. 2022;33:2049-2102. https://www.nice.org.uk/guidance/qs149/chapter/quality-statement-4-long-term-follow-up