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Glucocorticoid-induced osteoporosis — SCE Rheumatology MCQ

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ModerateMetabolic bone diseaseGlucocorticoid-induced osteoporosisSCE Rheumatology

A 72-year-old woman taking prednisolone 10 mg daily for vasculitis has a FRAX score above the intervention threshold and DEXA confirms femoral neck T-score -2.7. Calcium is normal and vitamin D is replete. What is the most appropriate management?

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Correct answer: C — Start oral bisphosphonate with bone protection advice

Glucocorticoid exposure plus high fracture risk and osteoporotic BMD warrants antiresorptive treatment, commonly an oral bisphosphonate if suitable. Waiting for a fracture is inappropriate prevention. Denosumab requires a long-term plan because stopping without follow-on therapy can cause rebound vertebral fractures.

Reference: NICE CG146; NOGG osteoporosis guideline