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Osteoporosis — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseOsteoporosisSCE Rheumatology

A 72-year-old woman sustains a low-trauma distal radius fracture after tripping from standing height. DEXA shows femoral neck T-score -2.8. Calcium, phosphate, ALP and renal function are normal. She can sit upright and has no oesophageal symptoms. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: E — Start oral alendronic acid with calcium and vitamin D assessment

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

Start oral alendronic acid with calcium and vitamin D assessment is best because fragility fracture with osteoporosis on DEXA warrants antiresorptive therapy such as oral alendronic acid if suitable. A is less suitable because allopurinol treats gout; B is less suitable because wrist fragility fracture is clinically relevant and should not be dismissed; C is less suitable because methotrexate does not reduce fragility fractures; E is less suitable because prednisolone worsens bone loss. Clinical pearl: fracture risk, not just hip fracture history, drives osteoporosis treatment.

Reference: NICE TA464; NOGG osteoporosis guideline