skip to main content

Bisphosphonate complication — SCE Rheumatology MCQ

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

HardMetabolic bone diseaseBisphosphonate complicationSCE Rheumatology

A patient taking long-term alendronate reports new thigh pain. Radiography shows an incomplete lateral-cortex atypical femoral fracture. What additional imaging action is required?

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

Reveal the answer and explanation

Correct answer: B — Obtain dedicated radiographs of the contralateral femur

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

C is correct. NOGG highlights that atypical femoral fractures are frequently bilateral, so the opposite femur should be imaged even if asymptomatic. The antiresorptive should be reviewed, weight bearing limited and orthopaedic input obtained. DXA cannot define a cortical stress lesion, lumbar or dental imaging addresses different adverse effects, and waiting for completion invites displacement.

Reference: NOGG 2024 clinical guideline. https://www.nogg.org.uk/sites/nogg/download/NOGG-Guideline-2024.pdf?v4=