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Glucocorticoid-induced vertebral fracture — SCE Acute Medicine MCQ

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ModerateMusculoskeletal systemGlucocorticoid-induced vertebral fractureSCE Acute Medicine

A 62-year-old woman on long-term prednisolone for polymyalgia rheumatica presents with back pain after lifting a bag. She is afebrile and neurologically intact. X-ray shows an acute wedge compression fracture at T12. Corrected calcium is normal and myeloma screen is pending. What is the most appropriate next step in management?

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Correct answer: E — Provide analgesia, assess osteoporosis risk and arrange antiresorptive bone protection

Long-term glucocorticoid therapy is a major risk factor for osteoporotic vertebral fracture. Management includes analgesia, assessment for secondary causes and fracture prevention with bone-protective therapy according to risk. Discitis would be suggested by fever, raised inflammatory markers or infection risk features, which are not present here.

Reference: NOGG Osteoporosis Guideline; BNF Bisphosphonates