Bone metabolism drugs (bisphosphonates, RANKL inhibitors)Downloads

A 67-year-old woman presents to her physician for a regular checkup. She is a community-dwelling, retired teacher without any smoking history. She has arterial hypertension and takes hydrochlorothiazide 12.5 mg and valsartan 80 mg daily. She was recently discharged from the hospital after admission for an ulnar fracture she received after a fall from the second step of a ladder in her garden. A year ago, she had a clavicular fracture from tripping over some large rocks in her yard. She does not report lightheadedness or fainting. Her medical history is also significant for an appendectomy 11 years ago. She is in menopause. She mostly consumes vegetables and dairy products. Her height is 163 cm (5 ft 4 in) and weight is 55 kg (123 lb). Her blood pressure is 130/80 mm Hg without orthostatic changes, heart rate is 73/min and regular, respiratory rate is 14/min, and temperature is 36.6°C (97.9°F). Her lungs are clear to auscultation. Cardiac auscultation reveals S2 accentuation over the aorta. The abdomen is mildly distended on palpation; there are no identifiable masses. The neurological examination is unremarkable. Considering the history and presentation, which of the following medications most likely will be prescribed to this patient after additional investigations?