Osteoporosis in CKD — RACP Adult Medicine MCQ

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ModerateGeriatric MedicineOsteoporosis in CKDRACP Adult Medicine

A 72-year-old woman with AF on rivaroxaban develops a mechanical fall and wrist fracture. Her DEXA shows T-score -2.8 at the hip. She has CKD stage 3a (eGFR 55). What is the most appropriate osteoporosis treatment?

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Correct answer: E — Zoledronic acid 5 mg IV annually

For a patient with osteoporotic fracture and CKD stage 3a (eGFR >30), oral bisphosphonates are first-line but adherence can be problematic. Zoledronic acid (annual IV infusion) ensures compliance and is appropriate with eGFR >35 mL/min. Denosumab is an alternative – particularly useful in CKD stage 4–5 where bisphosphonates are contraindicated, but requires strict adherence to 6-monthly dosing to avoid rebound fractures on cessation. In this patient on anticoagulation, fall prevention is also critical.

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