Osteoporosis — KFP-style written assessment

KFP 1 (10 marks)

A 66-year-old woman attends after a fall from standing height onto her outstretched hand resulting in a distal radius fracture. DXA shows femoral-neck T-score −1.8. She takes omeprazole long-term, walks daily, BMI 21 kg/m²; her mother broke a hip at 74. ^[5]

1. Does she need treatment despite T-score above −2.5? Justify. (3) ^[7]
2. Which secondary-cause screen will you order? (4)
3. Her FRAX 10-year major-osteoporotic risk sits just below the NOGG line for her age. What is your plan? (3) ^[7]

Model answers

1. Yes — a fragility fracture (low-trauma wrist fracture in an adult over 50) defines treatment need regardless of T-score. The fracture itself outranks the densitometry number. ^[7]
2. Calcium, phosphate, ALP, creatinine, LFTs, vitamin D, PTH if calcium abnormal, TSH, coeliac serology; review PPI necessity; consider early menopause status. ^[7]
3. A fragility fracture already places her in the treat category; NOGG thresholds guide the grey zone only when there has been no fracture. Treat now with a first-line bisphosphonate, correct vitamin D if low, recheck FRAX trajectory at review rather than deferring therapy.