Vertebral fracture — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseVertebral fractureSCE Rheumatology

A 77-year-old woman develops acute thoracic back pain after lifting shopping. She has kyphosis and focal spinal tenderness. She takes prednisolone for PMR. Neurological examination is normal and there is no fever. What is the most appropriate investigation?

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Correct answer: B — Spinal radiograph or vertebral fracture imaging

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · A = shown as D · B = shown as E

Spinal radiograph or vertebral fracture imaging is best because acute focal spinal pain in an older glucocorticoid-treated patient should prompt imaging for vertebral fragility fracture. A is less suitable because Schirmer test assesses dry eye; B is less suitable because synovial fluid analysis is for hot joints; D is less suitable because anti-CCP assesses RA risk; E is less suitable because temporal artery biopsy assesses GCA. Clinical pearl: vertebral fractures are often underdiagnosed unless specifically imaged.

Reference: NOGG osteoporosis guideline; NICE osteoporosis quality standards