Question:
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?
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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
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The Correct Option is A
Solution and Explanation
Step 1: Identify the clinical context.
A 60-year-old female with a previous Colles fracture (fragility fracture of the distal radius) and backache -- this is osteoporosis until proven otherwise. The question asks which statement is WRONG regarding treatment.
Step 2: Evaluate each option.
Option A -- Teriparatide should be started before supplementing bisphosphonates: This is WRONG. The correct sequence is bisphosphonates FIRST (antiresorptive therapy). Teriparatide (an anabolic agent / PTH analogue) is used AFTER bisphosphonates, especially in severe osteoporosis or when bisphosphonates fail. Moreover, teriparatide is contraindicated if bisphosphonates are given simultaneously because prior antiresorptive therapy blunts the anabolic effect of teriparatide.
Option B -- Bisphosphonates not given for more than a year: This is relatively correct in the context that after 3-5 years of bisphosphonate therapy, a drug holiday is considered due to risk of atypical femoral fractures and osteonecrosis of the jaw. Some guidelines restrict to shorter durations in specific contexts.
Option C -- Calcium requirement is 1200 mg per day: Correct. Postmenopausal women require 1200 mg/day of elemental calcium.
Option D -- Oral Vit D3 given along with oral calcium: Correct. Vitamin D supplementation is standard alongside calcium for osteoporosis management.
Step 3: Confirm the wrong statement.
Option A is incorrect because antiresorptive agents (bisphosphonates) are given BEFORE teriparatide, not after.
A 60-year-old female with a previous Colles fracture (fragility fracture of the distal radius) and backache -- this is osteoporosis until proven otherwise. The question asks which statement is WRONG regarding treatment.
Step 2: Evaluate each option.
Option A -- Teriparatide should be started before supplementing bisphosphonates: This is WRONG. The correct sequence is bisphosphonates FIRST (antiresorptive therapy). Teriparatide (an anabolic agent / PTH analogue) is used AFTER bisphosphonates, especially in severe osteoporosis or when bisphosphonates fail. Moreover, teriparatide is contraindicated if bisphosphonates are given simultaneously because prior antiresorptive therapy blunts the anabolic effect of teriparatide.
Option B -- Bisphosphonates not given for more than a year: This is relatively correct in the context that after 3-5 years of bisphosphonate therapy, a drug holiday is considered due to risk of atypical femoral fractures and osteonecrosis of the jaw. Some guidelines restrict to shorter durations in specific contexts.
Option C -- Calcium requirement is 1200 mg per day: Correct. Postmenopausal women require 1200 mg/day of elemental calcium.
Option D -- Oral Vit D3 given along with oral calcium: Correct. Vitamin D supplementation is standard alongside calcium for osteoporosis management.
Step 3: Confirm the wrong statement.
Option A is incorrect because antiresorptive agents (bisphosphonates) are given BEFORE teriparatide, not after.
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