GP CCE Cases · metabolic-and-endocrine-health
Distal radius fracture in a 66-year-old — CCE clinical encounter
CCE-style clinical encounter: a woman attends after a low-trauma wrist fracture. The candidate must recognise the fragility fracture as the diagnosis, screen for secondary causes, initiate bisphosphonate therapy with harms counselling, and set review and holiday expectations.
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Prompt
A 66-year-old woman attends after falling from standing height onto her outstretched hand; the plaster came off this week from a distal radius fracture. She walks daily, BMI 21 kg/m², menopause at 44, takes omeprazole long-term for reflux, smoked until five years ago, and her mother broke a hip at 74. She asks whether she needs 'those bone tablets'.
Objectives
- Recognise the fragility fracture itself as the diagnosis — DXA confirms but does not gate treatment. [1]
- Order the secondary-cause screen including coeliac serology, vitamin D, TSH and PTH where indicated. [1]
- Initiate alendronate with correct administration counselling and explicit AFF/ONJ harms discussion. [2]
- Address her long-term PPI use as a modifiable factor. [1]
- Set the five-year review and drug-holiday framework so therapy has a horizon. [1]
References2ShowHide
- [1]Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis Arch Osteoporos, 2022.PMID 35378630
- [2]Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research J Bone Miner Res, 2014.PMID 23712442