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Glucocorticoid-induced osteoporosis — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseGlucocorticoid-induced osteoporosisSCE Rheumatology

A 24-year-old man is starting prednisolone 40 mg daily for vasculitis and has a previous vertebral fragility fracture. 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: CEarly vertebral fracture

Early vertebral fracture is the single best answer because high-dose prolonged glucocorticoids rapidly increase fracture risk. 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