Endocrine drugs: glucocorticoid-induced osteoporosis: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Endocrine drugs: glucocorticoid-induced osteoporosis

Sample item

A man with rheumatoid arthritis on prednisolone 10 mg daily for two years is found to have a low bone density. Which drug is the usual first-line therapy for prevention of fractures, and how does it act?

ATeriparatide, which inhibits osteoclastsBRaloxifene, which stimulates osteoclastsCAlendronate, which inhibits osteoclast-mediated resorptionDCalcitriol alone, which stimulates osteoblasts

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Alendronate, which inhibits osteoclast-mediated resorption

Bisphosphonates bind bone mineral and inhibit farnesyl pyrophosphate synthase in osteoclasts, reducing resorption. They are first-line for glucocorticoid-induced osteoporosis, with calcium and vitamin D. They should be taken upright with water to avoid oesophagitis.

Option by option

A. Teriparatide, which inhibits osteoclasts
Teriparatide stimulates bone formation and does not inhibit osteoclasts.
B. Raloxifene, which stimulates osteoclasts
Raloxifene reduces osteoclast activity rather than stimulating it.
C. Alendronate, which inhibits osteoclast-mediated resorption (correct)
Correct. A bisphosphonate reduces osteoclast activity and fracture risk.
D. Calcitriol alone, which stimulates osteoblasts
Calcitriol alone does not give adequate fracture protection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Alendronate, which inhibits osteoclast-mediated resorption. Bisphosphonates bind bone mineral and inhibit farnesyl pyrophosphate synthase in osteoclasts, reducing resorption.

Why is "Teriparatide, which inhibits osteoclasts" not the answer?

Teriparatide stimulates bone formation and does not inhibit osteoclasts.

Why is "Raloxifene, which stimulates osteoclasts" not the answer?

Raloxifene reduces osteoclast activity rather than stimulating it.

Why is "Calcitriol alone, which stimulates osteoblasts" not the answer?

Calcitriol alone does not give adequate fracture protection.

What concept does this question test?

It tests Endocrine drugs: glucocorticoid-induced osteoporosis in Pharmacology. They are first-line for glucocorticoid-induced osteoporosis, with calcium and vitamin D. They should be taken upright with water to avoid oesophagitis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrine drugs: glucocorticoid-induced osteoporosis?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.