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Osteoporosis — SCE Rheumatology MCQ

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HardMetabolic bone diseaseOsteoporosisSCE Rheumatology

A 79-year-old woman has multiple vertebral fractures and hip T-score −3.4 despite adherence to oral bisphosphonate therapy. What is the best next step?

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Correct answer: D — Seek specialist very-high-risk therapy including an anabolic option

The best answer is “Seek specialist very-high-risk therapy including an anabolic option”. Multiple vertebral fractures and very low BMD despite treatment indicate very high risk and possible treatment failure, requiring adherence and secondary-cause review and consideration of specialist anabolic-first or sequential therapy. Continuing unchanged, stopping therapy, calcium alone or waiting for hip fracture leaves substantial imminent risk untreated.

Reference: NOGG pharmacological treatment options: https://www.nogg.org.uk/full-guideline/section-6-pharmacological-treatment-options