Which therapy is described as a last-resort option for osteoporosis in postmenopausal women?

• A. Calcitonin
• B. Raloxifene
• C. Zoledronic acid
• D. Teriparatide

Answer: (A)

Treatment of osteoporosis in postmenopausal women is guided by fracture risk, with a stepwise approach that escalates to therapies that rebuild bone when risk remains very high or when other agents fail. An anabolic option that really stands out for last-resort use is teriparatide, a recombinant parathyroid hormone analog. It works by stimulating osteoblasts and promoting new bone formation, which translates into meaningful gains in bone density and solid reductions in vertebral and nonvertebral fractures. Because its benefit comes from building bone, it’s typically reserved for those at the highest fracture risk or for patients who have not tolerated or responded to antiresorptives like bisphosphonates or denosumab. The course is usually time-limited (about 18–24 months), after which a maintenance strategy with an antiresorptive helps preserve the gained bone. Calcitonin has a more modest effect on fracture risk and isn’t commonly used as a last-resort therapy. Raloxifene can reduce vertebral fracture risk but doesn’t address hip fractures as effectively and is not a last-resort option. Zoledronic acid is a potent antiresorptive often used earlier in treatment, not typically a last-resort choice.