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Osteoporotic Vertebral Fracture — RACP Adult Medicine MCQ

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EasyEndocrinologyOsteoporotic Vertebral FractureRACP Adult Medicine

A 75-year-old man presents with back pain and an L2 vertebral compression fracture after minimal trauma (bending to tie his shoe). He has a kyphotic posture and has lost 4 cm in height. DEXA shows a T-score of -3.2 at the lumbar spine. He is vitamin D replete. What is the most appropriate first-line pharmacological treatment for osteoporosis?

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Correct answer: C — Alendronate (oral bisphosphonate)

Osteoporotic fracture with T-score ≤-2.5 requires pharmacological treatment beyond calcium/vitamin D. Oral bisphosphonates (alendronate or risedronate) are first-line for osteoporosis. They reduce vertebral and non-vertebral fracture risk by 40–50%. For very high fracture risk (multiple fractures, T-score <-3.5), anabolic agents (teriparatide, romosozumab) may be considered as initial therapy.

Reference: RACGP/Osteoporosis Australia – 2024 – Osteoporosis Guidelines; ANZBMS