A 65-year-old postmenopausal woman has a T-score of -2.7 on DXA at the femoral neck, a FRAX 10-year probability of major osteoporotic fracture of 18%, and has had one prior fragility fracture of the wrist. According to current treatment guidelines (NICE/IOF), the most appropriate pharmacological management is:

• A Calcium and vitamin D supplementation alone
• B Teriparatide (recombinant PTH) as first-line therapy
• C Denosumab injection as first-line therapy without calcium supplementation
• D Oral bisphosphonate (alendronate 70 mg/week) plus calcium and vitamin D ✓

Explanation

The patient has a T-score of -2.7 (osteoporosis threshold <-2.5), a prior fragility fracture, and a high 10-year fracture probability (FRAX >20% for major fracture is 'high risk'). Oral bisphosphonates (alendronate, risedronate) are the first-line pharmacological treatment for postmenopausal osteoporosis with FRAX-indicated risk, combined with calcium and vitamin D supplementation. Teriparatide and denosumab are second-line agents reserved for treatment failures, intolerance to bisphosphonates, or very high-risk patients. Calcium/vitamin D alone is insufficient for an osteoporotic patient with prior fracture.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.