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Paget's disease of bone — SCE Rheumatology MCQ

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HardMetabolic Bone DiseasePaget's disease of boneSCE Rheumatology

A patient taking a bisphosphonate for eight years develops new persistent thigh pain without trauma. What investigation should be arranged for possible atypical femoral fracture?

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Correct answer: D — Bilateral full-length femoral radiographs, followed by MRI if equivocal

Prodromal thigh or groin pain during prolonged antiresorptive therapy warrants imaging for incomplete atypical femoral fracture. Both femora should be assessed because lesions can be bilateral, and MRI or other cross-sectional imaging follows when radiographs are unrevealing but suspicion persists.

Reference: NOGG clinical guideline for prevention and treatment of osteoporosis (Updated 2024): https://www.nogg.org.uk/full-guideline; NICE TA464: bisphosphonates for treating osteoporosis (Updated July 2019): https://www.nice.org.uk/guidance/ta464/chapter/1-Recommendations