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Osteoporosis — CCFP MCQ

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HardChronic disease managementOsteoporosisCCFP

A 70-year-old postmenopausal woman presents after a low-trauma distal radius fracture. DXA shows a T-score of −2.6 at the femoral neck. Her serum calcium is normal, 25-OH vitamin D is low, and eGFR is 58 mL/min/1.73 m². She is independent with no planned dental procedures. What is the most appropriate next step in her management?

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Correct answer: C — Correct vitamin D deficiency and initiate osteoporosis pharmacotherapy after shared decision-making

According to the 2023 Canadian Osteoporosis Canada guideline, pharmacotherapy is indicated for all postmenopausal women aged ≥70 years with a T-score ≤−2.5. This patient meets both criteria (age 70, T-score −2.6) and has sustained a major osteoporotic fracture (distal forearm), which is a strong indicator of high fracture risk regardless of T-score. Vitamin D deficiency must be corrected as part of baseline management before or concurrent with pharmacotherapy. The guideline emphasizes individualized treatment and shared decision-making. Option E is false: distal radius fractures are major osteoporotic fractures and predict future fracture risk. Option B incorrectly proposes menopausal hormone therapy, which is not first-line at age 70 and carries cardiovascular and thromboembolic risks. Option A advocates harmful delay in an appropriately indicated patient. Option D overstates calcitonin's role; bisphosphonates and denosumab are preferred first-line agents.

Reference: Morin SN, Feldman S, Funnell L, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update. CMAJ. 2023;195(39):E1333-E1348. https://www.cmaj.ca/content/195/39/E1333