skip to main content

Glucocorticoid-induced osteoporosis — SCE Rheumatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMetabolic Bone DiseaseGlucocorticoid-induced osteoporosisSCE Rheumatology

A 58-year-old man with ANCA vasculitis is starting prednisolone 60 mg daily with a planned taper over 6 months. He has a prior vertebral fragility fracture. Vitamin D is replete and eGFR is 72 mL/min/1.73 m². Dental review is satisfactory. 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 bone protection with an oral bisphosphonate

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

Start bone protection with an oral bisphosphonate is best because high-dose glucocorticoids plus previous vertebral fracture warrant immediate bone protection, commonly with a bisphosphonate if suitable. A is less suitable because men also develop glucocorticoid-induced osteoporosis; B is less suitable because waiting until after steroid exposure misses the highest bone-loss period; C is less suitable because denosumab requires calcium/vitamin D assessment and is not the default in this stem; D is less suitable because colchicine prevents gout flares rather than fractures. Clinical pearl: glucocorticoid bone protection should be considered at treatment initiation.

Reference: NOGG osteoporosis guideline; NICE TA464