Osteoporosis after fragility fracture — RACGP Fellowship MCQ

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ModerateMusculoskeletal and sportsOsteoporosis after fragility fractureRACGP Fellowship

A 74-year-old man is reviewed after a low-trauma distal radius fracture. He has not previously received osteoporosis treatment. Calcium intake is low and he takes intermittent prednisolone for polymyalgia rheumatica. What is the most appropriate initial investigation?

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Correct answer: E — Bone mineral density assessment

<cite index="10-9,10-11">RACGP guidance specifies that minimal trauma fracture at any site in persons >50 years qualifies for DXA assessment, and BMD guides management after fracture at sites other than hip or spine.</cite> This patient's distal radius fracture, age, and risk factors (low calcium, glucocorticoid use) necessitate bone mineral density measurement and fracture risk calculation. Serum urate is irrelevant (excludes A). Whole-body bone scans are not indicated for osteoporosis diagnosis (excludes B). The premise that wrist fractures are never osteoporotic is false and contradicts secondary prevention principles (excludes D). Spinal radiography lacks clinical indication without back pain (excludes E).

Reference: Royal Australian College of General Practitioners (RACGP). Osteoporosis risk assessment, diagnosis and management flowchart, 2017. https://www.racgp.org.au/FSDEDEV/media/documents/Clinical%20Resources/Guidelines/Joint%20replacement/Osteoporosis-flowchart.pdf