skip to main content

Bisphosphonate duration review — USMLE Step 3 MCQ

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

HardAmbulatory Medicine / Primary CareBisphosphonate duration reviewUSMLE Step 3

A 69-year-old woman has taken alendronate correctly for 5 years. She has had no fragility fracture, femoral-neck T-score is −2.0, vertebral imaging shows no occult fracture, and she takes no glucocorticoid. Renal function and calcium are normal. Which management is most appropriate?

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

Reveal the answer and explanation

Correct answer: C — Begin a monitored bisphosphonate holiday with periodic fracture-risk reassessment

The best answer is “Begin a monitored bisphosphonate holiday with periodic fracture-risk reassessment”. After 3–5 years of bisphosphonate exposure, fracture risk should be reassessed. With no fracture, a T-score above −2.5, and no major ongoing risk factor, she is low-to-moderate risk and may start a temporary holiday. Risk is reassessed every 2–4 years and treatment restarts for fracture, significant BMD decline, or rising risk. Denosumab must not be interrupted without follow-on antiresorptive therapy.

Reference: Endocrine Society Guideline: Osteoporosis in Postmenopausal Women: https://www.endocrine.org/clinical-practice-guidelines/osteoporosis-in-postmenopausal-women