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Osteoporosis treatment failure — SCE Endocrinology MCQ

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ModerateCalcium/BoneOsteoporosis treatment failureSCE Endocrinology

A 69-year-old woman with osteoporosis has vertebral fracture while taking alendronate correctly for 3 years. Calcium and vitamin D are replete, eGFR is 62 ml/min/1.73 m2 and adherence is confirmed. What is the most appropriate management?

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Correct answer: B — Specialist review for treatment failure and alternative anti-osteoporosis therapy

Fragility fracture despite appropriate bisphosphonate therapy warrants specialist reassessment for secondary causes, adherence, risk and alternative agents. Calcium alone is inadequate after fracture. Paget's disease would usually have characteristic radiology and raised ALP rather than being assumed.

Reference: NICE CG146; NOGG Guideline