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Osteoporosis after fragility fracture — MCCQE Part 1 MCQ

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HardFracturesOsteoporosis after fragility fractureMCCQE Part 1

A 74-year-old recovering from a low-trauma hip fracture has adequate calcium intake, corrected vitamin D deficiency and eGFR 58 mL/min/1.73 m². DXA access will take six months. What should happen to secondary fracture prevention?

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Correct answer: A — Start osteoporosis pharmacotherapy now and obtain baseline DXA when available

Obtain DXA confirmation before prescribing secondary-prevention pharmacotherapy: DXA refines baseline assessment but is not required to prove treatment eligibility after this sentinel fracture. Use calcium and vitamin D until a second fragility fracture occurs: Nutritional measures are necessary adjuncts but insufficient secondary prevention. Start osteoporosis pharmacotherapy now and obtain baseline DXA when available: After renal, calcium, vitamin D and dental considerations, an appropriate antiresorptive can be selected and adherence planning begun. Use annual hip radiographs to determine when systemic treatment is indicated: Plain radiographs do not quantify systemic fracture risk or prevent another fracture. Defer bisphosphonate-class treatment through radiographic fracture union: Appropriately timed bisphosphonate treatment does not need to be withheld indefinitely for fear of preventing union.

Reference: https://osteoporosis.ca/2023-cpg/