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Severe Osteoporosis Treatment — RACP Adult Medicine MCQ

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HardEndocrinologySevere Osteoporosis TreatmentRACP Adult Medicine

A 72-year-old woman with severe osteoporosis (T-score -4.0, two vertebral fractures) has a contraindication to bisphosphonates (oesophageal stricture) and denosumab (hypocalcaemia risk with CKD 4). What is the most appropriate alternative?

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Correct answer: A — Teriparatide

Severe osteoporosis with contraindications to bisphosphonates and denosumab warrants an anabolic agent. Teriparatide (recombinant PTH 1-34) stimulates osteoblastic bone formation, increasing BMD and reducing fracture risk. It is given as a daily SC injection for up to 24 months, after which an antiresorptive agent must follow to maintain gains. Romosozumab is an alternative anabolic agent.

Reference: RACGP/Osteoporosis Australia – 2024 – Osteoporosis Guidelines