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Fragility fracture risk — SCE Rheumatology MCQ

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HardMetabolic bone diseaseFragility fracture riskSCE Rheumatology

A 66-year-old woman takes aromatase inhibitor therapy and has height loss. Examination shows thoracic kyphosis is present. Investigations show plain radiograph suggests an old vertebral wedge fracture. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Bone scintigraphy to measure generalized osteoblast activity

The best answer is “Bone scintigraphy to measure generalized osteoblast activity”. DEXA with vertebral fracture assessment quantifies bone density and detects vertebral fractures in a high-risk patient. Serum urate and autoantibodies do not assess fragility fracture risk. A vertebral fracture can establish high fracture risk even when symptoms are modest. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: NOGG fracture-risk assessment: https://www.nogg.org.uk/full-guideline/section-3-fracture-risk-assessment-and-case-finding