A 70-year-old postmenopausal woman with DXA T-score of -2.8 at the femoral neck has a 10-year FRAX probability of major osteoporotic fracture of 22%. She has already sustained a vertebral compression fracture. What is the first-line pharmacological treatment?
- A Alendronate (oral bisphosphonate) 70 mg weekly with calcium and Vitamin D ✓
- B Calcium and Vitamin D supplementation alone
- C Teriparatide (PTH 1-34) subcutaneous injection daily
- D Denosumab 60 mg subcutaneous every 6 months
Explanation
Oral bisphosphonates (alendronate or risedronate) remain first-line therapy for postmenopausal osteoporosis with T-score ≤-2.5 or with fragility fracture. They reduce osteoclast-mediated bone resorption via inhibition of farnesyl pyrophosphate synthase in the mevalonate pathway, reducing vertebral fractures by ~50% and hip fractures by ~40% with evidence from large RCTs. Teriparatide is reserved for severe osteoporosis, multiple fractures, or bisphosphonate failure/intolerance due to cost and anabolic mechanism. Denosumab is preferred when GFR <30 or bisphosphonate compliance issues. Calcium/Vitamin D alone do not meet fracture prevention threshold in established osteoporosis.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.