Question:medium
60 year old elderly female with previous h/o Colles fracture is complaining of backache. Which of the given statements is wrong in relation to treatment of this patient?
60 year old elderly female with previous h/o Colles fracture is complaining of backache. Which of the given statements is wrong in relation to treatment of this patient?
Show Hint
Recall the correct sequence of osteoporosis pharmacotherapy -- which drug class is first-line and which is reserved for refractory cases.
Updated On: Jun 23, 2026
- Teriparatide should be started before supplementing bisphosphonates
- Bisphosphonates not given for more than a year
- Calcium requirement is 1200 mg per day
- Oral Vit D3 given along with oral calcium
Show Solution
The Correct Option is A
Solution and Explanation
Stepwise evaluation of osteoporosis treatment statements:
Clinical background: 60-year-old female, Colles fracture (fragility fracture), backache $\rightarrow$ diagnosis is osteoporosis.
Evaluate each option for correctness:
Option A -- WRONG: Teriparatide before bisphosphonates? No. The standard treatment algorithm is:
Step 1: Calcium $1200$ mg/day + Vitamin D $800{-}1000$ IU/day
Step 2: Bisphosphonates (e.g., alendronate, risedronate) -- first-line antiresorptive agents
Step 3: Teriparatide (anabolic PTH analogue) -- reserved for severe/refractory cases AFTER bisphosphonates
Antiresorptive agents suppress osteoclast activity and are used before the bone-forming agent teriparatide.
Option B -- Bisphosphonates not > 1 year: Debatable; drug holiday after 3-5 years is recommended, but not after just 1 year.
Option C -- Calcium 1200 mg/day: Correct for postmenopausal women (NOF recommendation).
Option D -- Vit D3 + oral calcium: Correct standard practice.
The clearly wrong statement is A.
\[\boxed{\text{Teriparatide should be started before supplementing bisphosphonates (WRONG)}}\]
Clinical background: 60-year-old female, Colles fracture (fragility fracture), backache $\rightarrow$ diagnosis is osteoporosis.
Evaluate each option for correctness:
Option A -- WRONG: Teriparatide before bisphosphonates? No. The standard treatment algorithm is:
Step 1: Calcium $1200$ mg/day + Vitamin D $800{-}1000$ IU/day
Step 2: Bisphosphonates (e.g., alendronate, risedronate) -- first-line antiresorptive agents
Step 3: Teriparatide (anabolic PTH analogue) -- reserved for severe/refractory cases AFTER bisphosphonates
Antiresorptive agents suppress osteoclast activity and are used before the bone-forming agent teriparatide.
Option B -- Bisphosphonates not > 1 year: Debatable; drug holiday after 3-5 years is recommended, but not after just 1 year.
Option C -- Calcium 1200 mg/day: Correct for postmenopausal women (NOF recommendation).
Option D -- Vit D3 + oral calcium: Correct standard practice.
The clearly wrong statement is A.
\[\boxed{\text{Teriparatide should be started before supplementing bisphosphonates (WRONG)}}\]
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