GP Vivas · metabolic-and-endocrine-health
Osteoporosis — structured viva
Structured oral on osteoporosis: defending bisphosphonate first-line with honest harms, the denosumab rebound trap, anabolic-first sequencing from DATA, romosozumab's cardiovascular warning, and vitamin D honesty.
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Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'A patient read that bone drugs cause jaw death and broken thighs — why would anyone take them?' The viva branches through risk-benefit counselling, denosumab discipline, sequencing and the vitamin D myth.
Stem
You are the GP. A journalist headline about 'bone drugs causing shattered thighs' has half your practice frightened. [4]
References5ShowHide
- [1]Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis (FREEDOM) N Engl J Med, 2009.PMID 19671655
- [2]Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis (HORIZON) N Engl J Med, 2007.PMID 17476007
- [3]Tsai JN, Uihlein AV, Lee H, et al. Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study Lancet, 2013.PMID 23683600
- [4]Saag KG, Petersen J, Brandi ML, et al. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis (ARCH) N Engl J Med, 2017.PMID 28892457
- [5]Bolland MJ, Grey A, Avenell A Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis Lancet Diabetes Endocrinol, 2018.PMID 30293909