AANP Family Nurse Practitioner (FNP) Certification ExamPlanMedium
A 62-year-old male presents for a follow-up visit after being diagnosed with osteoporosis. His DEXA scan T-score is -2.8 at the femoral neck. He has no history of fractures, is generally healthy, and has no contraindications to oral medications. Which of the following is the most appropriate first-line pharmacological management for this patient?
- ATeriparatide subcutaneous injection daily
- BRaloxifene oral tablet daily
- CAlendronate oral tablet once weekly
- DDenosumab subcutaneous injection every 6 months
Show answer & explanationAnswer & explanation
Correct answer: C. Alendronate oral tablet once weekly
Oral bisphosphonates, such as alendronate, are generally recommended as first-line pharmacological treatment for most patients with osteoporosis without a history of severe or atypical fractures. They are effective, well-studied, and cost-effective.
Why the other options are wrong
- A. Teriparatide is an anabolic agent reserved for patients with severe osteoporosis, very high fracture risk, or those who have failed other therapies.
- B. Raloxifene is a selective estrogen receptor modulator (SERM) primarily used in postmenopausal women, often with a focus on vertebral fractures, and not typically first-line for general osteoporosis treatment.
- D. Denosumab is an effective option, but typically reserved for patients who cannot tolerate oral bisphosphonates, have renal impairment, or are at very high risk of fracture.
Osteoporosis First-Line Tx
First-line pharmacological treatment for osteoporosis in most patients involves oral bisphosphonates to reduce fracture risk.
- Oral bisphosphonates (e.g., alendronate, risedronate) are standard first-line.
- Other agents (denosumab, teriparatide) are reserved for specific high-risk or intolerant patients.
- Lifestyle modifications (calcium, vitamin D, weight-bearing exercise) are crucial adjuncts.
Memory trick: Bisphosphonates Build Bones First!