A 65-Year-Old Man Comes to the Physician to Follow Up

question 345

Multiple Choice

A 65-year-old man comes to the physician to follow up polymyalgia rheumatica with giant cell arteritis.  He was started on 60 mg/day of prednisone 6 weeks ago and has been tapered to 20 mg/day.  The patient has been taking 1,200 mg/day of supplemental calcium as well as 800 IU/day of vitamin D.  He has no visual symptoms.  His morning shoulder stiffness and aches have dissipated, and he feels well overall.  Blood pressure is 136/84 mm Hg and pulse is 72/min.  His weight is 77 kg (169.4 lb) , an increase from 72 kg (158.4 lb) 2 months ago.  The patient has no temporal artery tenderness.  The remainder of his physical examination is within normal limits.  Laboratory results are as follows:

Dual-energy x-ray absorptiometry reveals a T-score of −1.3 at the lumbar spine and −1.2 at the femoral neck.  Which of the following is the best next step in preventing fragility fractures in this patient?

• A)Calcitonin
• B)Daily weight-bearing exercises
• C)Denosumab
• D)Repeat dual-energy x-ray absorptiometry in 6-12 months
• E)Risedronate

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