A 55-year-old woman is prescribed prednisolone 10 mg daily for polymyalgia rheumatica, expected to continue beyond 3 months. DXA shows a T-score of -2.2 and FRAX predicts a major osteoporotic fracture probability above the treatment threshold. What is the correct management?

• A Repeat DXA after 12 months of steroids before starting therapy
• B Start calcium and vitamin D supplementation alone
• C Start a bisphosphonate along with calcium and vitamin D ✓
• D Start hormone replacement therapy

Explanation

Glucocorticoids cause rapid bone loss concentrated in the first months of therapy, so prophylaxis must begin at initiation when prednisolone equals or exceeds 7.5 mg daily for 3 months or longer in patients at elevated risk. Bisphosphonates are the first line agents and are proven to prevent both vertebral and non-vertebral fractures in steroid users. Calcium and vitamin D alone are insufficient adjuncts, not definitive therapy, which kills option B, and deferring treatment until fracture or further loss occurs is inappropriate.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.