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GCA Biopsy Histology — SCE Rheumatology MCQ

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HardVasculitisGCA Biopsy HistologySCE Rheumatology

A 68-year-old taking prednisolone 10 mg daily has an unadjusted FRAX 10-year hip-fracture probability of 5.0% and major-osteoporotic-fracture probability of 16.0%. What dose adjustment does NOGG apply?

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Reveal the answer and explanation

Correct answer: A — Hip 6.0% and major osteoporotic fracture 18.4%

Explanation lettering: E = shown as C · C = shown as E

A is correct. Prednisolone 10 mg/day is in the high-dose FRAX category of at least 7.5 mg/day. NOGG increases hip-fracture probability by 20%: 5.0 × 1.20 = 6.0%. It increases major-osteoporotic-fracture probability by 15%: 16.0 × 1.15 = 18.4%. The adjustment corrects the average-dose assumption built into the glucocorticoid checkbox; very high doses above 20 mg/day can require greater clinical adjustment. Treatment should not be delayed in patients who already meet immediate high-risk criteria.

Reference: NOGG: strategies for osteoporosis and fracture-risk management: https://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk