Question:medium
60 year old elderly female with previous h/o colles fracture is complaining of backache. Which of the given statement 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 statement is wrong in relation to treatment of this patient?
Show Hint
Think about the correct sequence of antiresorptive versus anabolic therapy in osteoporosis management.
Updated On: Jun 23, 2026
- Teriparatide should be started before supplementing bisphosphonates
- Bisphosphonates not given for more than a year
- Calcium requirement is 1200mg per day
- Oral Vit D3 given along with oral calcium
Show Solution
The Correct Option is A
Solution and Explanation
Osteoporosis Treatment -- Identifying the Wrong Statement
Drugs for osteoporosis classified by mechanism:
- Antiresorptive (reduce bone loss): Bisphosphonates, Denosumab, SERMs (Raloxifene), Calcitonin
- Anabolic (build bone): Teriparatide (PTH 1-34), Abaloparatide, Romosozumab
Correct treatment sequence:
1. Calcium 1200 mg/day + Vitamin D3 (baseline for all patients)
2. Bisphosphonates (first-line antiresorptive): given for 3-5 years then drug holiday considered
3. Teriparatide: reserved for severe osteoporosis, multiple fractures, or bisphosphonate failure -- ALWAYS after, not before, bisphosphonates
Why Option A is WRONG:
Prior bisphosphonate use actually reduces the anabolic efficacy of teriparatide. The correct practice is: give bisphosphonates first; if still at high fracture risk, switch to teriparatide. Starting teriparatide before bisphosphonates has no evidence base and reverses the recommended sequence.
Colles fracture in a 60-year-old female = fragility fracture = osteoporosis diagnosis confirmed clinically even without DEXA.
\[\boxed{\text{Option A: Teriparatide before bisphosphonates (WRONG statement)}}\]
Drugs for osteoporosis classified by mechanism:
- Antiresorptive (reduce bone loss): Bisphosphonates, Denosumab, SERMs (Raloxifene), Calcitonin
- Anabolic (build bone): Teriparatide (PTH 1-34), Abaloparatide, Romosozumab
Correct treatment sequence:
1. Calcium 1200 mg/day + Vitamin D3 (baseline for all patients)
2. Bisphosphonates (first-line antiresorptive): given for 3-5 years then drug holiday considered
3. Teriparatide: reserved for severe osteoporosis, multiple fractures, or bisphosphonate failure -- ALWAYS after, not before, bisphosphonates
Why Option A is WRONG:
Prior bisphosphonate use actually reduces the anabolic efficacy of teriparatide. The correct practice is: give bisphosphonates first; if still at high fracture risk, switch to teriparatide. Starting teriparatide before bisphosphonates has no evidence base and reverses the recommended sequence.
Colles fracture in a 60-year-old female = fragility fracture = osteoporosis diagnosis confirmed clinically even without DEXA.
\[\boxed{\text{Option A: Teriparatide before bisphosphonates (WRONG statement)}}\]
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