A 77-year-old man with a history of falls has a DXA scan showing a T-score of -1.8 at the femoral neck and -2.0 at the lumbar spine. His FRAX 10-year ...

Question

A 77-year-old man with a history of falls has a DXA scan showing a T-score of -1.8 at the femoral neck and -2.0 at the lumbar spine. His FRAX 10-year probability of major osteoporotic fracture is 15% and hip fracture 4.5%. He has no previous fractures. According to NICE NG188, what is the MOST appropriate management?

Accepted Answer

His T-scores indicate osteopenia, not osteoporosis, and his FRAX score is below the treatment threshold - lifestyle advice and calcium/vitamin D supplementation are appropriate, with reassessment in 3-5 years

Answer

Start Alendronic acid 70 mg weekly immediately

Answer

Refer for intravenous Zoledronic acid

Answer

Start Denosumab immediately

Answer

No follow-up is needed

uk-dgm MCQ (SBA): Osteopenia Management and FRAX Interpretation