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Osteoporosis after fracture — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsOsteoporosis after fractureGPhC CRA

A postmenopausal patient at high fracture risk has severe oesophageal reflux and dysphagia. Corrected calcium is normal and eGFR is 62 mL/min/1.73 m². Which treatment route is most appropriate to discuss?

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

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Correct answer: D — Assess intravenous zoledronate after renal calcium and dental checks

Assess intravenous zoledronate after renal calcium and dental checks: The oesophageal disorder makes oral bisphosphonate administration unsafe, while renal function and calcium do not preclude assessment for intravenous zoledronate. Crush weekly alendronate into food and continue oral treatment: Crushing does not prevent oesophageal exposure and food abolishes reliable absorption. Use weekly risedronate immediately before the patient lies down: Another oral bisphosphonate retains important swallowing and upright-posture constraints. Withhold all antiresorptive treatment because the oesophagus is diseased: Non-oral therapies remain available after individual risk assessment. Start denosumab after calcium testing but omit a discontinuation plan: Denosumab requires mineral assessment and a discontinuation strategy to avoid rebound vertebral fractures.

Reference: NOGG clinical guideline for osteoporosis: https://www.nogg.org.uk/full-guideline; BNF: zoledronic acid: https://bnf.nice.org.uk/drugs/zoledronic-acid/