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Fragility vertebral compression fracture in steroid-treated older adult — SCE Acute Medicine MCQ

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ModerateMedicine in the elderlyFragility vertebral compression fracture in steroid-treated older adultSCE Acute Medicine

An 86-year-old woman presents after a low-energy fall with new back pain and difficulty mobilising. She has lost height, takes prednisolone for polymyalgia and has mid-thoracic tenderness without neurological deficit. X-ray shows a new wedge compression fracture. What is the most appropriate next step in management?

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Correct answer: C — Provide analgesia, mobilisation support and assess for osteoporosis treatment

A low-trauma vertebral compression fracture in an older woman on steroids is a fragility fracture and should trigger analgesia, mobilisation, falls review and osteoporosis assessment or treatment. Prolonged bed rest worsens deconditioning and complications. Urgent surgery is not indicated without instability, cord compression or refractory severe pain.

Reference: NICE CG146 osteoporosis; NICE NG56 multimorbidity