A 70-year-old woman sustains a vertebral compression fracture spontaneously. DXA scan shows a T-score of -2.8. Serum calcium, phosphate, and alkaline phosphatase are normal. The most appropriate primary treatment is:

• A Calcium and vitamin D supplementation alone
• B Hormone replacement therapy with oestrogen
• C Calcitonin injections
• D Bisphosphonate therapy (e.g., alendronate) with calcium and vitamin D ✓

Explanation

A T-score of -2.5 or below defines osteoporosis by WHO criteria, and a fragility fracture at -2.8 indicates established osteoporosis requiring pharmacological intervention. Bisphosphonates (alendronate, risedronate) are the first-line agents; they inhibit osteoclastic bone resorption, reduce vertebral fracture risk by approximately 50%, and are given with calcium and vitamin D supplementation. Normal biochemistry excludes osteomalacia, which would have a different treatment approach.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.