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Paget symptomatic disease — SCE Rheumatology MCQ

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ModerateMetabolic bone diseasePaget symptomatic diseaseSCE Rheumatology

A 72-year-old man has Paget disease with focal bone pain and raised ALP. Examination shows bone scan shows active disease in the pelvis. Investigations show renal function is normal. What is the most appropriate management?

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Correct answer: D — Intravenous zoledronic acid

Intravenous zoledronic acid is the most appropriate management because it addresses the underlying metabolic bone risk. The alternatives either do not prevent fracture, treat a different disease, or delay necessary intervention. Fracture prevention should begin promptly after fragility fracture or high-risk glucocorticoid exposure.

Reference: NOGG osteoporosis guideline; NICE CG146; BNF