skip to main content

Secondary prevention after hip fracture — SCE Geriatric Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateOrthogeriatricsSecondary prevention after hip fractureSCE Geriatric Medicine

An 88-year-old woman is recovering after hemiarthroplasty for a displaced intracapsular neck of femur fracture. She lived alone with two carers daily, has eGFR 48 mL/min/1.73 m² and corrected calcium is normal. DXA would be difficult because she cannot transfer safely and she has not received previous bone protection. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Start bone protection with oral bisphosphonate if tolerated, plus calcium and vitamin D if dietary intake is inadequate

A low-trauma hip fracture in an older woman is sufficient evidence of very high fracture risk and should trigger secondary fracture prevention without waiting for DXA if imaging is impractical. An oral bisphosphonate is a usual first-line option when renal function and swallowing permit; calcium and vitamin D are adjuncts when intake or status is inadequate. Raloxifene is not used for hip fracture prevention in this scenario, and anabolic therapy is generally specialist-led for selected very-high-risk cases. Orthogeriatric care should also address falls, nutrition and rehabilitation.

Reference: NICE CG146; NOGG 2024; BOA/BGS Blue Book