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Osteoporosis — SCE Rheumatology MCQ

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HardMetabolic bone diseaseOsteoporosisSCE Rheumatology

A 33-year-old premenopausal woman sustains a low-trauma distal-radius fracture and has a femoral-neck T-score of −2.8. What is the best next management step?

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Correct answer: D — Arrange specialist metabolic-bone assessment for secondary causes and pregnancy plans

The best answer is “Arrange specialist metabolic-bone assessment for secondary causes and pregnancy plans”. A fragility fracture and markedly low bone density in a premenopausal woman require evaluation for secondary disease and individualized treatment that considers future pregnancy and prolonged skeletal retention of some medicines. Empirical indefinite bisphosphonate or denosumab treatment is not automatic, the fracture is not expected physiology, and postmenopausal T-score thresholds should not be applied in isolation.

Reference: NOGG assessment of younger people at high fracture risk: https://www.nogg.org.uk/full-guideline/section-3-fracture-risk-assessment-and-case-finding