What is the most appropriate treatment?

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A 72-year-old woman was referred for bone density assessment after sustaining a fracture of her right ankle after a minor fall. She had previously fractured her right wrist after tripping in the street. Her past medical history included occasional angina relieved by glyceryl trinitrate spray and a previous deep venous thrombosis. Her medication comprised aspirin, simvastatin, alendronic acid, and calcium and vitamin D, which she had been taking regularly for 2 years.

Investigations:

DXA scan of spine (L2CL4)T score C2.4

DXA scan of total hipT score C2.8

What is the most appropriate treatment?
A . continue alendronic acid
B . switch alendronic acid to pamidronate
C . switch alendronic acid to raloxifene
D . switch alendronic acid to strontium ranelate
E . switch alendronic acid to teriparatide

Answer: A

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