A 70-year-old postmenopausal woman with a DXA T-score of -2.7 at the femoral neck sustains a fragility fracture. FRAX tool calculation gives a 10-year probability of major osteoporotic fracture of 22%. The MOST appropriate pharmacological treatment is:
- A Oral bisphosphonate (alendronate weekly) ✓
- B Calcium and vitamin D supplementation alone
- C Hormone replacement therapy (estrogen)
- D Calcitonin nasal spray
Correct answer: A. Oral bisphosphonate (alendronate weekly)
Explanation
A T-score of -2.7 with a fragility fracture confirms osteoporosis. WHO guidelines and current Indian/international osteoporosis guidelines recommend oral bisphosphonates (alendronate 70 mg weekly or risedronate 35 mg weekly) as first-line pharmacotherapy for postmenopausal osteoporosis, having the strongest evidence for reducing vertebral, non-vertebral, and hip fracture risk. HRT is second-line for postmenopausal women. Calcium/vitamin D alone is insufficient in established osteoporosis. Calcitonin is now rarely recommended as fracture efficacy is weak.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.