A 58-year-old woman is started on prednisolone 7.5 mg daily for polymyalgia rheumatica, expected to continue for over three months. Alongside calcium and vitamin D, which class of drug should be added to prevent glucocorticoid-induced osteoporosis given her age and planned duration of therapy?

• A Thiazide diuretic
• B Teriparatide as first-line prophylaxis
• C Calcitonin nasal spray
• D Bisphosphonate ✓

Explanation

Patients over 65 years, or those with a previous fragility fracture, who take glucocorticoids at any dose for three months or longer qualify for primary prophylaxis with a bisphosphonate such as alendronate or risedronate. Calcitonin is inferior and reserved for selected cases, while teriparatide is second line for established fractures rather than routine prophylaxis.

Reference: American College of Rheumatology Guideline for Prevention and Treatment of Glucocorticoid-Induced Osteoporosis, 2017 update ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.