A 75-Year-Old Woman Comes to the Office Due to a Compression

question 311

Multiple Choice

A 75-year-old woman comes to the office due to a compression fracture of her tenth thoracic vertebra after slipping in the bathtub.  Her medical history is notable for hypertension, hyperlipidemia, type 2 diabetes mellitus, gastroesophageal reflux disease, and stage 4 chronic kidney disease.  The patient is compliant with all of her medications, including calcium and vitamin D supplementation.
Laboratory results are as follows:
DXA shows a T-score of −2.0 at the lumbar spine and −1.8 at the femoral neck.
In addition to continuing vitamin D and calcium supplementation, which of the following is the best therapeutic option to decrease this patient's risk of future fractures?

• A)Alendronate orally
• B)Calcitonin intranasally
• C)Denosumab subcutaneously
• D)FRAX assessment tool calculation to determine treatment
• E)Teriparatide subcutaneously