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Atypical femoral fracture — SCE Rheumatology MCQ

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HardMetabolic Bone DiseaseAtypical femoral fractureSCE Rheumatology

A 67-year-old man has taken alendronate for 9 years and reports prodromal thigh pain with lateral femoral cortical beaking on radiography. What is the most important complication to screen for?

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

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Correct answer: A — Complete atypical femoral fracture

Complete atypical femoral fracture is the single best answer because long-term bisphosphonate exposure with lateral cortical stress change suggests atypical femoral fracture. The stem is testing complication screening, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Osteomalacia is less suitable because it fits a different clinical pattern or a different treatment threshold; Multiple myeloma, Plain radiograph alone and Methotrexate do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NOGG osteoporosis guideline; NICE technology appraisals; BNF