Paget's disease and osteoporosis therapy — SCE Endocrinology MCQ

Correct answer: A — Evaluate suspected Paget disease before selecting teriparatide therapy

The best answer is “Evaluate suspected Paget disease before selecting teriparatide therapy”. Teriparatide should not be used in metabolic bone disease other than osteoporosis, including Paget disease; unexplained marked alkaline phosphatase elevation therefore requires resolution before anabolic selection. “Begin teriparatide because raised alkaline phosphatase predicts anabolic response” is less appropriate because already accelerated disordered bone remodelling is a contraindicating context rather than an efficacy marker “Repeat bone-specific alkaline phosphatase before selecting osteoporosis therapy” is less appropriate because Paget disease can have normal calcium and still requires evaluation “Use calcium alone as definitive treatment for both conditions” is less appropriate because calcium does not correct focal disorganised remodelling or provide adequate fracture therapy “Start carbimazole to reduce skeletal turnover” is less appropriate because carbimazole treats thyroid hormone synthesis, not Paget disease

Reference: Forsteo 20 micrograms/80 microlitres: SmPC. https://www.medicines.org.uk/emc/product/2215/smpc Paget disease of bone: clinical guideline. https://pmc.ncbi.nlm.nih.gov/articles/PMC6522384/