skip to main content

Vertebral fragility fractures with CKD4 — SCE Geriatric Medicine MCQ

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

HardOrthogeriatricsVertebral fragility fractures with CKD4SCE Geriatric Medicine

An 85-year-old has a new vertebral fragility fracture, eGFR 24 mL/min/1.73 m², low vitamin D and previous severe oesophagitis on alendronate. Calcium is normal. Which bone-health plan is most appropriate?

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

Reveal the answer and explanation

Correct answer: A — Correct vitamin D and obtain CKD-aware specialist bone assessment

Explanation lettering: C = shown as A · E = shown as C · A = shown as D · D = shown as E

A avoids oesophageal exposure but zoledronate is unsuitable at this level of renal impairment. B ignores severe hypocalcaemia risk and the need to distinguish osteoporosis from CKD-mineral bone disorder. C is correct: correct vitamin D, assess calcium, phosphate, PTH and alkaline phosphatase, then select antiresorptive or anabolic therapy with specialist CKD-aware input. D risks an inappropriate anabolic agent if high-turnover bone disease is present. E makes an invasive test a universal prerequisite and delays secondary prevention.

Reference: NOGG: osteoporosis and chronic kidney disease: https://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk