How you knew
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Choose on the leftThe reasoning, and the treatment, land here.
The four fingerprints in one line. Osteoporosis: calcium normal, phosphate normal, ALP normal, DEXA low. Osteomalacia: calcium low or low-normal, phosphate low, ALP high, vitamin D low, PTH high. Paget disease: calcium normal, phosphate normal, ALP very high. Hyperparathyroidism: calcium high, phosphate low, PTH high.
The teaching, in order
- Nothing yet — clear the pre-dose checks first.
The rest of the shelf, and what makes each one dangerous. Zoledronic acid 5 mg IV yearly — hydrate before and after, expect a flu-like acute-phase reaction for 24 to 72 hours after the first dose, check calcium and renal function first. Denosumab 60 mg subcutaneously every 6 months — usable in renal impairment but check calcium first, and never simply stop it without transitioning to another agent, because rebound vertebral fractures follow discontinuation. Raloxifene 60 mg daily — increases VTE risk, so stop it before prolonged immobility or surgery. Teriparatide and abaloparatide — anabolic, daily subcutaneous, generally limited to about 2 years of lifetime use; watch for orthostatic dizziness after the first doses. Romosozumab monthly for 12 months — boxed warning for myocardial infarction, stroke and cardiovascular death; avoid within one year of either.