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Atypical fracture assessment — DGM MCQ

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HardFallsAtypical fracture assessmentDGM

An 81-year-old woman taking long-term bisphosphonate therapy reports new dull thigh pain before a minor fall. Femoral X-ray shows cortical thickening without complete fracture. She has been on alendronic acid for nine years. Current medicines include alendronic acid and calcium/vitamin D. What is the most appropriate assessment?

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Correct answer: C — Orthopaedic assessment and review of bisphosphonate therapy

Prodromal thigh pain and femoral cortical thickening during long-term bisphosphonate therapy suggest an atypical femoral fracture risk. Increasing the dose, ignoring the finding, high-impact exercise and treating as a simple strain could increase fracture risk. Long-term osteoporosis therapy should be periodically reviewed, especially when new thigh pain develops.

Reference: BNF; NICE CG146