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Osteopenia with high FRAX risk — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareOsteopenia with high FRAX riskUSMLE Step 3

A 68-year-old woman with osteopenia asks about vitamin D and fracture prevention. DXA T-score is -2.1 at the femoral neck. FRAX 10-year hip fracture risk is 4.1% and major osteoporotic fracture risk is 22%. Calcium intake is low. She has no prior fragility fracture. Which of the following is the most appropriate next step in management?

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Correct answer: B — Recommend bisphosphonate therapy and calcium/vitamin D optimization

Osteopenia with FRAX hip fracture risk at or above 3% or major osteoporotic fracture risk at or above 20% warrants pharmacologic therapy, typically an oral bisphosphonate, along with calcium and vitamin D optimization.

Reference: Endocrine Society/National Osteoporosis Foundation osteoporosis treatment guidance