uk-dgm MCQ (SBA): First-Line Osteoporosis Treatment

A 84-year-old woman with a history of three fragility fractures (Colles' fracture, vertebral crush fracture, and a recent hip fracture) is reviewed in the fracture liaison service. She has CKD stage 3a (eGFR 52 mL/min/1.73m²). She is not currently on bone protection therapy. DXA scan shows a T-score of -3.2 at the femoral neck. She takes Calcium 1 g and Colecalciferol 800 units daily. What is the MOST appropriate bone protection therapy to initiate?