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MPO-ANCA Association — SCE Rheumatology MCQ

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HardVasculitisMPO-ANCA AssociationSCE Rheumatology

A 71-year-old on long-term oral glucocorticoids has no known fracture and femoral-neck T-score −1.9, but measured height has fallen 4.5 cm from early-adult height. What additional case-finding test is recommended?

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Correct answer: B — Lateral spine radiography or DXA vertebral-fracture assessment

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

B is correct. NOGG recommends looking for a vertebral fracture when height loss is at least 4 cm, and also with kyphosis, acute back pain plus osteoporosis risk, current or recent long-term oral glucocorticoids, or BMD T-score at or below −2.5. Vertebral fractures are commonly silent and materially increase imminent risk. Repeat hip DXA or turnover markers can miss this diagnostic information, while routine whole-spine MRI or isotope scanning is unnecessary for uncomplicated case finding.

Reference: NOGG: summary of main recommendations: https://www.nogg.org.uk/full-guideline/summary-main-recommendations