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Osteoporosis Post-Fracture — RACP Adult Medicine MCQ

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EasyGeriatric MedicineOsteoporosis Post-FractureRACP Adult Medicine

A 75-year-old man with a recent hip fracture and osteoporosis (T-score -3.5) should commence osteoporosis treatment. He has stage 3 CKD (eGFR 45 mL/min/1.73 m²). What is the most appropriate first-line treatment?

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Correct answer: E — Alendronate 70 mg weekly

For osteoporosis with fragility fracture, bisphosphonates (alendronate or risedronate) are first-line therapy in Australia. With eGFR >30 mL/min/1.73 m², alendronate is appropriate without dose adjustment. Below eGFR 30, bisphosphonates are generally avoided and denosumab becomes preferred. Teriparatide is PBS-listed for severe osteoporosis with fractures who fail or are intolerant of bisphosphonates. Calcium (1200 mg/day) and vitamin D (800–1000 IU/day) supplementation is essential.

Reference: RACGP – 2017 – Osteoporosis Clinical Guideline; eTG – 2025 – Rheumatology