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Osteoporosis — SCE Rheumatology MCQ

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EasyMetabolic bone diseaseOsteoporosisSCE Rheumatology

A 63-year-old woman has a low-trauma distal radius fracture and height loss. Examination shows there is thoracic kyphosis without focal neurological signs. Investigations show DXA shows a femoral neck T-score of -2.8. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: E — Denosumab

Denosumab is the best answer because denosumab is the most appropriate next step for osteoporosis in this clinical setting. Therapeutic exercise is a plausible distractor, but it does not account for the key discriminator in the stem. Vitamin D replacement and Oral prednisolone would be more appropriate in a different clinical pattern or at another point in the pathway, while Zoledronic acid infusion is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: NICE CG146; NOGG guideline; BNF