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Osteoporosis Treatment CKD G3 — ESENeph MCQ

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HardChronic Kidney DiseaseOsteoporosis Treatment CKD G3ESENeph

A 68-year-old with CKD G3a has a fragility vertebral fracture, osteoporosis by DXA, mildly raised PTH and normal calcium and phosphate. Which treatment principle is most appropriate?

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Correct answer: A — CKD-MBD optimisation followed by fracture-risk-directed osteoporosis treatment

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

C is correct. The fracture creates a strong treatment indication, but the biochemical abnormality means management should integrate its magnitude, reversibility and trajectory with eGFR, calcium, phosphate, alkaline phosphatase and fracture risk. KDIGO no longer makes bone biopsy a universal prerequisite before antiresorptives; it is considered when turnover knowledge would materially change the choice. A assumes adynamic bone disease. B ignores CKD-MBD context. D makes an optional diagnostic tool mandatory. E assigns calcitriol a fracture-treatment role it does not have. Drug selection then accounts for renal clearance and the risk of hypocalcaemia.

Reference: KDIGO 2017 CKD-MBD guideline update: https://kdigo.org/wp-content/uploads/2018/04/2017-KDIGO-CKD-MBD-GL-Update.pdf