A 70-year-old patient who has a high fracture risk has been taking alendronate (Fosamax) and calcium for 6 months. The primary care NP orders a urine NTx level, which is 42 . The NP should discontinue the alendronate and prescribe:
a. raloxifene (Evista).
b. teriparatide (Forteo).
c. calcitonin (Miacalcin nasal spray).
d. ibandronate sodium (Boniva).
B
Teriparatide is used in patients with a high fracture risk or in whom bisphosphonate therapy has failed. Raloxifene and ibandronate are second-line treatments for patients with usual fracture risks. Calcitonin is a last-line treatment.
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