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Biology, Genetics & Bone Healing MCQs

Practice Set 110 of 212

This practice set contains high-yield board review questions covering key concepts in Biology, Genetics & Bone Healing. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2181

Topic: Biology, Genetics & Bone Healing

A 5-year-old child presents with multiple long bone fractures since infancy, blue sclera, and hearing loss. Radiographs show generalized osteopenia and 'popcorn' calcifications at the metaphyses. Genetic testing confirms Osteogenesis Imperfecta (OI) Type I. Beyond fracture management, what is the most important long-term therapeutic intervention to improve bone strength and reduce fracture rates in this child?

. Growth hormone therapy.
. Oral calcium and Vitamin D supplementation.
. Intravenous bisphosphonate therapy (e.g., pamidronate).
. Regular strenuous weight-bearing exercise.
. Surgical limb lengthening.

Correct Answer & Explanation

. Intravenous bisphosphonate therapy (e.g., pamidronate).

Explanation

The clinical presentation is classic for Osteogenesis Imperfecta (OI). While good nutrition (including calcium and vitamin D) and gentle physical activity are important, the most effective medical therapy to increase bone mineral density, reduce fracture frequency, and improve mobility in children with OI is intravenous bisphosphonate therapy (C), such as pamidronate or zoledronic acid. Growth hormone (A) is not indicated for OI. Oral calcium and Vitamin D (B) are supportive but not sufficient as primary treatment for severe osteopenia. Strenuous weight-bearing exercise (D) can be risky due to fracture risk and is not the primary intervention for bone strength itself. Surgical limb lengthening (E) is a reconstructive procedure for deformity, not a primary treatment for bone fragility.

Question 2182

Topic: Biology, Genetics & Bone Healing

A 70-year-old male presents with increasing left thigh pain, warmth, and bowing of the left femur. Radiographs show cortical thickening, bone enlargement, and a 'V-shaped' lytic lesion in the subtrochanteric region. Alkaline phosphatase levels are significantly elevated. A bone scan shows increased uptake in the left femur. What is the most appropriate management for this symptomatic patient with active Paget's disease?

. Immediate prophylactic intramedullary nailing.
. High-dose NSAIDs and observation.
. Oral bisphosphonates (e.g., alendronate).
. Intravenous zoledronic acid.
. Calcium and Vitamin D supplementation.

Correct Answer & Explanation

. Intravenous zoledronic acid.

Explanation

This patient has symptomatic Paget's disease with features highly suggestive of an impending pathological fracture ('V-shaped' lytic lesion in the subtrochanteric region, bowing, pain). Elevated alkaline phosphatase confirms active disease. The most effective treatment for active and symptomatic Paget's disease is intravenous bisphosphonates, particularly zoledronic acid (D), which powerfully suppresses osteoclast activity, normalizes alkaline phosphatase, reduces pain, and can facilitate bone healing. Prophylactic nailing (A) might be considered if the 'V-shaped' lesion is a complete transverse fissure or very large, but the primary medical management targets the underlying disease first. NSAIDs (B) only provide symptomatic relief. Oral bisphosphonates (C) are an option but less potent/rapid than IV forms for acute, severe disease. Calcium and Vitamin D (E) are supportive but not primary treatment for Paget's.

Question 2183

Topic: Biology, Genetics & Bone Healing

A 4-month-old infant presents with recurrent fractures, poor weight gain, and frontal bossing. Laboratory investigations reveal very low serum alkaline phosphatase (ALP) levels, elevated plasma pyridoxal-5'-phosphate (PLP), and normal serum calcium and phosphate. What is the most likely diagnosis, and what is the current targeted therapeutic approach?

. Rickets due to Vitamin D deficiency; high-dose oral Vitamin D supplementation.
. Osteogenesis Imperfecta Type II; bisphosphonate therapy.
. Hypophosphatasia; enzyme replacement therapy with asfotase alfa.
. Achondroplasia; limb lengthening procedures.
. X-linked hypophosphatemia; oral phosphate and active Vitamin D analogues.

Correct Answer & Explanation

. Hypophosphatasia; enzyme replacement therapy with asfotase alfa.

Explanation

The combination of recurrent fractures, poor weight gain (failure to thrive), frontal bossing, remarkably low serum alkaline phosphatase (ALP) levels, and elevated plasma pyridoxal-5'-phosphate (PLP) is pathognomonic for Hypophosphatasia (HPP). HPP is a rare genetic disorder characterized by defective bone mineralization due to a deficiency of tissue-nonspecific alkaline phosphatase (TNAP). The current targeted therapy for HPP is enzyme replacement therapy with asfotase alfa, which provides recombinant human TNAP. Rickets (Option A) would typically show low phosphate and/or high ALP depending on type. Osteogenesis Imperfecta (Option B) is a collagen disorder, not primarily an ALP deficiency. Achondroplasia (Option D) is a dwarfism disorder, not typically associated with low ALP or recurrent fractures in infancy. X-linked hypophosphatemia (Option E) presents with low phosphate and rickets, but not low ALP.

Question 2184

Topic: Biology, Genetics & Bone Healing
A 45-year-old male presents with recurrent pathological fractures, dental abnormalities (e.g., premature tooth loss), and chronic bone pain. Laboratory evaluation reveals normal calcium, phosphate, PTH, and 25-hydroxyvitamin D levels. Alkaline phosphatase is mildly elevated. Genetic testing confirms mutations in the tissue-nonspecific alkaline phosphatase (TNSALP) gene. Which of the following is the most definitive treatment for this patient's underlying condition?
. Bisphosphonates
. Teriparatide
. Enzyme replacement therapy with asfotase alfa
. High-dose vitamin D supplementation
. Phosphate binders

Correct Answer & Explanation

. Enzyme replacement therapy with asfotase alfa

Explanation

The clinical presentation (pathological fractures, dental abnormalities, chronic bone pain, normal Ca/Phos/PTH/Vit D, elevated ALP, TNSALP gene mutation) is classic for adult hypophosphatasia. Asfotase alfa is a recombinant human tissue-nonspecific alkaline phosphatase (TNSALP) that replaces the deficient enzyme, addressing the underlying genetic defect. This enzyme replacement therapy improves bone mineralization, leading to reduced fracture rates and improved muscle strength in affected individuals. Bisphosphonates are contraindicated as they inhibit bone turnover and can worsen mineralization in hypophosphatasia.

Question 2185

Topic: Biology, Genetics & Bone Healing

A 30-year-old male with X-linked hypophosphatemic rickets presents with chronic bone pain, pseudofractures, and progressive lower extremity deformity despite conventional phosphate and calcitriol therapy. Which of the following newer therapeutic agents is most likely to improve his symptoms and reduce pseudofracture burden by targeting the underlying pathophysiology?

. Denosumab.
. Teriparatide.
. Burosumab.
. Romosozumab.
. Alendronate.

Correct Answer & Explanation

. Burosumab.

Explanation

Burosumab is a monoclonal antibody that targets fibroblast growth factor 23 (FGF23), which is overproduced in X-linked hypophosphatemic rickets (XLH). By inhibiting FGF23, Burosumab increases renal phosphate reabsorption and calcitriol production, directly addressing the underlying pathophysiology of XLH. This leads to improved phosphate levels, reduced bone pain, and healing of rickets and pseudofractures, even in patients refractory to conventional therapy. The other agents listed are for osteoporosis or other metabolic bone diseases but do not specifically target FGF23 in XLH.

Question 2186

Topic: Biology, Genetics & Bone Healing

A 68-year-old female presents with a 6-month history of insidious onset left anterior thigh pain. She has been on alendronate for osteoporosis for 10 years. Radiographs show focal lateral cortical thickening in the subtrochanteric region of the left femur, with a short transverse fracture line extending medially. No acute trauma is reported. Which of the following is the most appropriate initial management step?

. Immediate operative fixation with an intramedullary nail.
. Discontinue alendronate, initiate teriparatide, and monitor with serial radiographs.
. Discontinue alendronate, supplement with calcium and Vitamin D, and consider prophylactic contralateral femoral nailing.
. Conservative management with protected weight-bearing and observation, continue alendronate.
. Discontinue alendronate, consider prophylactic ipsilateral intramedullary nailing, and evaluate the contralateral femur.

Correct Answer & Explanation

. Discontinue alendronate, consider prophylactic ipsilateral intramedullary nailing, and evaluate the contralateral femur.

Explanation

This patient presents with a prodromal atypical femoral fracture (AFF) in the left femur, characterized by focal cortical thickening and a transverse fracture line, along with a history of long-term bisphosphonate use. The pain indicates an impending or incomplete fracture. The most appropriate initial management involves discontinuing the bisphosphonate. Prophylactic intramedullary nailing of the affected femur is generally recommended for symptomatic incomplete AFFs due to the high risk of complete fracture. Additionally, the contralateral femur should be evaluated as AFFs can be bilateral (occurring in 50-80% of cases). Teriparatide can be considered for fracture healing, but the immediate concern is mechanical stability. Option A is for complete fractures. Option B and D do not address the mechanical instability adequately. Option C is incomplete as it doesn't mention ipsilateral fixation.

Question 2187

Topic: Biology, Genetics & Bone Healing

A 10-year-old boy presents with progressive bilateral genu valgum. Physical examination reveals an intermalleolar distance of 10 cm with the knees touching. Radiographs show widening of the physes, metaphyseal flaring, and irregular physeal margins, particularly at the distal femurs and proximal tibias. Laboratory tests reveal low serum phosphate, elevated alkaline phosphatase, and normal serum calcium and PTH. What is the most likely diagnosis?

. Renal osteodystrophy.
. Vitamin D-dependent rickets Type I.
. Blount's disease.
. X-linked hypophosphatemia.
. Scurvy.

Correct Answer & Explanation

. X-linked hypophosphatemia.

Explanation

The clinical presentation (progressive genu valgum, widening physes, metaphyseal flaring) and laboratory findings (low serum phosphate, elevated alkaline phosphatase, normal serum calcium and PTH) are classic for X-linked hypophosphatemia (XLH), also known as Vitamin D-resistant rickets. XLH is the most common hereditary form of rickets, characterized by impaired renal phosphate reabsorption and decreased 1-alpha hydroxylation of Vitamin D, leading to chronic hypophosphatemia. Renal osteodystrophy (Option A) would typically involve abnormalities in calcium, phosphate, and PTH, often in the context of chronic kidney disease. Vitamin D-dependent rickets Type I (Option B) is characterized by low 1,25-dihydroxyvitamin D and typically presents with hypocalcemia. Blount's disease (Option C) is a growth disturbance of the medial proximal tibia, causing genu varum, not valgum, and is not primarily a metabolic bone disease. Scurvy (Option E) is Vitamin C deficiency and has different radiographic and biochemical features.

Question 2188

Topic: Biology, Genetics & Bone Healing

What is the biomechanical reason that IM nailing is generally preferred over plating for most diaphyseal long bone fractures?

. IM nails provide absolute stability, promoting direct healing.
. IM nails are less prone to infection due to their internal placement.
. IM nails offer load-sharing, reducing stress shielding compared to plates.
. Plates require larger incisions and more soft tissue stripping.
. IM nails prevent rotational motion completely.

Correct Answer & Explanation

. IM nails offer load-sharing, reducing stress shielding compared to plates.

Explanation

The primary biomechanical advantage of IM nailing over plating for diaphyseal fractures is its load-sharing capability. By being centrally located, the nail shares axial and bending loads with the bone, allowing the bone to be physiologically stressed. This reduces stress shielding, promotes robust secondary callus formation, and often leads to faster and more reliable healing compared to plates which typically function as load-bearing devices and are more prone to stress shielding. While soft tissue stripping is a surgical advantage, load-sharing is a direct biomechanical benefit.

Question 2189

Topic: Biology, Genetics & Bone Healing

In a scenario of a non-union after IM nailing, which change to the locking screw configuration is most likely to promote healing if the non-union is hypertrophic?

. Adding more locking screws to increase stability.
. Converting from static to dynamic locking.
. Replacing all locking screws with larger diameter screws.
. Removing the nail and performing plate fixation.
. Changing the nail material to titanium.

Correct Answer & Explanation

. Converting from static to dynamic locking.

Explanation

A hypertrophic non-union implies adequate biological potential but too much motion. In this scenario, converting from static to dynamic locking (by removing one set of screws) allows for controlled axial micromotion and increased load transfer across the fracture site. This controlled compression and appropriate interfragmentary strain can stimulate callus maturation and bridging, leading to consolidation. Adding more screws would increase stiffness, which is usually not the problem with hypertrophic non-unions.

Question 2190

Topic: Biology, Genetics & Bone Healing

What biomechanical concept explains why a small amount of callus formation is desirable around an IM nail, as opposed to direct bone healing?

. Callus formation indicates primary bone healing, which is faster.
. Callus increases the load-bearing capacity of the nail.
. Callus is formed in response to controlled micromotion (relative stability) and contributes to the progressive stiffening and healing of the fracture.
. Direct bone healing leads to stress shielding.
. Callus prevents infection.

Correct Answer & Explanation

. Callus is formed in response to controlled micromotion (relative stability) and contributes to the progressive stiffening and healing of the fracture.

Explanation

Intramedullary nailing provides relative stability, allowing for controlled micromotion at the fracture site. This micromotion, within a specific range of interfragmentary strain, is a potent stimulus for secondary bone healing, which involves callus formation. The progressive maturation and mineralization of this callus lead to the gradual stiffening and eventual consolidation of the fracture. Direct bone healing, requiring absolute stability, typically results in minimal or no visible callus.

Question 2191

Topic: Biology, Genetics & Bone Healing

The concept of 'biological fixation' with IM nails is rooted in which biomechanical principle?

. Rigid stabilization to promote primary cortical healing.
. Minimizing soft tissue disruption to preserve vascularity and promote secondary healing.
. Maximizing the implant-bone interface for immediate load transfer.
. Using porous-coated nails to encourage osteointegration.
. Achieving absolute stability to prevent micromotion.

Correct Answer & Explanation

. Minimizing soft tissue disruption to preserve vascularity and promote secondary healing.

Explanation

Biological fixation, particularly relevant to IM nailing, emphasizes minimizing iatrogenic soft tissue disruption during surgery. This approach aims to preserve the existing periosteal and endosteal blood supply, which is critical for fracture healing. By maintaining a healthy biological environment around the fracture, the IM nail, acting as a load-sharing device providing relative stability, encourages robust secondary bone healing through callus formation. It is less about rigid stabilization or osteointegration (though porous nails exist), and more about supporting the body's natural healing processes.

Question 2192

Topic: Biology, Genetics & Bone Healing

A 45-year-old woman presents with diffuse bone pain, muscle weakness, and multiple stress fractures. Her history includes a remote gastrectomy for peptic ulcer disease and prolonged use of proton pump inhibitors. Lab results show hypocalcemia, hypophosphatemia, elevated alkaline phosphatase, and elevated parathyroid hormone (PTH). Her 25-hydroxyvitamin D level is significantly low. What is the most likely diagnosis and primary treatment target?

. Primary hyperparathyroidism; parathyroidectomy.
. Osteoporosis; bisphosphonate therapy.
. Renal osteodystrophy; phosphate binders and active vitamin D.
. Oncogenic osteomalacia; tumor localization and resection.
. Acquired osteomalacia due to malabsorption; high-dose vitamin D and calcium supplementation.

Correct Answer & Explanation

. Acquired osteomalacia due to malabsorption; high-dose vitamin D and calcium supplementation.

Explanation

The patient's clinical presentation (diffuse bone pain, muscle weakness, stress fractures) and lab findings (hypocalcemia, hypophosphatemia, elevated PTH, elevated alkaline phosphatase, low 25-hydroxyvitamin D) are classic for osteomalacia. The history of gastrectomy and prolonged PPI use strongly suggests malabsorption. Primary hyperparathyroidism (A) would typically present with hypercalcemia. Osteoporosis (B) would not typically cause hypophosphatemia or such elevated alkaline phosphatase. Renal osteodystrophy (C) would show kidney dysfunction, and the primary cause here points to the gut. Oncogenic osteomalacia (D) typically presents with isolated hypophosphatemia but normal calcium and PTH. Therefore, the most likely diagnosis isacquired osteomalacia due to malabsorption, and the primary treatment target is to correct the vitamin D deficiency and calcium balance (E). This involves high-dose vitamin D supplementation (often calciferol followed by cholecalciferol) and calcium supplementation to address the malabsorption caused by gastrectomy and PPI use.

Question 2193

Topic: Biology, Genetics & Bone Healing

A 70-year-old male is found to have elevated serum alkaline phosphatase (ALP) and characteristic findings of Paget's disease on X-rays (thickened cortex, trabecular coarsening) involving his tibia and pelvis. He is asymptomatic. Which of the following is generally considered an indication for medical treatment with bisphosphonates in Paget's disease?

. Elevated alkaline phosphatase alone
. Involvement of weight-bearing bones (e.g., tibia)
. Asymptomatic skull involvement
. Anticipated surgery in an affected bone
. Normal hearing

Correct Answer & Explanation

. Involvement of weight-bearing bones (e.g., tibia)

Explanation

Indications for medical treatment (typically with bisphosphonates) in Paget's disease include: symptomatic disease (bone pain, neurological symptoms like hearing loss, nerve compression), active disease in high-risk locations (e.g., skull near vital structures, spine, weight-bearing long bones with risk of fracture), or prior to surgery on an affected bone to reduce hypervascularity and bone turnover, thereby minimizing blood loss and improving bone quality. Elevated ALP alone without symptoms is often observed, but not an absolute indication for treatment. Asymptomatic involvement of the skull is not an indication unless it is progressive or near vital structures. Normal hearing is not an indication for treatment.

Question 2194

Topic: Biology, Genetics & Bone Healing

A 70-year-old female on long-term bisphosphonate therapy (alendronate for 7 years) for osteoporosis presents with dull, aching thigh pain for 6 months. A recent fall resulted in a complete, transverse fracture of the subtrochanteric femur with characteristic cortical thickening laterally. What is the most important component of her management, in addition to surgical fixation?

. Continue bisphosphonate therapy to prevent further fractures.
. Initiate immediate high-dose calcium and Vitamin D supplementation.
. Discontinue bisphosphonate therapy.
. Weight-bearing as tolerated to stimulate bone healing.
. Referral for genetic testing for bone fragility.

Correct Answer & Explanation

. Discontinue bisphosphonate therapy.

Explanation

This patient presents with a classic atypical femoral fracture (AFF), which is strongly associated with long-term bisphosphonate use. While surgical fixation (typically intramedullary nailing) is necessary for a complete fracture, the most important medical management is to discontinue bisphosphonate therapy. Bisphosphonates suppress bone turnover, which is thought to contribute to the accumulation of microdamage and lead to these characteristic fractures. Continuing bisphosphonates would hinder bone healing. Calcium and Vitamin D are generally part of osteoporosis management but are not the primary, immediate medical management for an AFF. Weight-bearing is not indicated until after stable surgical fixation, and genetic testing is not typically indicated for AFFs.

Question 2195

Topic: Biology, Genetics & Bone Healing

An 82-year-old female presents with a distal radius fragility fracture. Her DEXA scan reveals a T-score of -3.2 at the lumbar spine and -3.0 at the femoral neck. She has been on oral alendronate for 5 years and has previously fractured her vertebral body and humerus. Her renal function is normal. Which of the following is the most appropriate next step in her osteoporosis management?

. Increase the dose of alendronate.
. Switch to another oral bisphosphonate like risedronate.
. Initiate an anabolic agent such as teriparatide or romosozumab.
. Prescribe calcium and Vitamin D supplementation only.
. Discontinue all osteoporosis medications due to bisphosphonate failure.

Correct Answer & Explanation

. Initiate an anabolic agent such as teriparatide or romosozumab.

Explanation

This patient has severe osteoporosis with multiple fragility fractures despite 5 years of oral bisphosphonate therapy, indicating a 'failure' of bisphosphonate treatment. In such cases, switching to an anabolic agent is the most appropriate next step. Teriparatide (a parathyroid hormone analog) and romosozumab (a sclerostin inhibitor) are potent bone-forming agents that are highly effective in patients who fail bisphosphonates or have very severe osteoporosis. Increasing the dose of alendronate or switching to another oral bisphosphonate is unlikely to be effective. Calcium and Vitamin D are supportive but not sufficient for severe osteoporosis. Discontinuing medication would leave her at very high risk for further fractures.

Question 2196

Topic: Biology, Genetics & Bone Healing

A 72-year-old female with severe osteoporosis is started on romosozumab. This medication increases bone mineral density by binding to and inhibiting sclerostin. Sclerostin normally functions to inhibit which of the following cellular pathways?

. RANK/RANKL signaling pathway
. Wnt/beta-catenin signaling pathway
. Osteoprotegerin (OPG) pathway
. Bone morphogenetic protein (BMP) pathway
. Insulin-like growth factor 1 (IGF-1) pathway

Correct Answer & Explanation

. Wnt/beta-catenin signaling pathway

Explanation

Sclerostin is a glycoprotein secreted primarily by osteocytes that inhibits bone formation by binding to LRP5/6 receptors on osteoblasts, thereby antagonizing the canonical Wnt/beta-catenin signaling pathway. Romosozumab is a monoclonal antibody that neutralizes sclerostin, unblocking the Wnt pathway and strongly stimulating bone formation.

Question 2197

Topic: Biology, Genetics & Bone Healing

During a gradual deformity correction and lengthening of the tibia using a hexapod circular frame, the patient develops premature consolidation of the regenerate bone. Which of the following factors most likely predisposed the patient to this complication?

. A distraction rate of 1.0 mm per day
. A latency period of 2 days prior to starting distraction
. Performing the corticotomy with a Gigli saw rather than a drill
. A distraction rhythm of 0.25 mm every 6 hours
. A latency period of 14 days prior to starting distraction

Correct Answer & Explanation

. A latency period of 14 days prior to starting distraction

Explanation

A prolonged latency period (e.g., 14 days) allows for excessive callus formation before distraction forces are applied, significantly increasing the risk of premature consolidation. The standard latency period for diaphyseal lengthening is typically 5 to 7 days.

Question 2198

Topic: Biology, Genetics & Bone Healing

A 35-year-old man presents with chronic, dull, aching pain and stiffness in his right lower extremity. Radiographs reveal dense, irregular, eccentric hyperostosis along the cortex of the femur and tibia, resembling dripping candle wax. Which of the following is the most likely genetic mutation associated with this condition?

. COMP
. GNAS
. FGFR3
. LEMD3
. SOX9

Correct Answer & Explanation

. LEMD3

Explanation

Correct Answer: LEMD3The clinical and radiographic description (dripping candle wax appearance along the cortex) is pathognomonic for Melorheostosis. This is a rare, non-hereditary sclerosing bone dysplasia characterized by anarchic, hyperostotic bone formation. It is frequently associated with somatic loss-of-function mutations in the LEMD3 gene (also known as MAN1), which is involved in bone morphogenetic protein (BMP) and TGF-beta signaling. LEMD3 mutations are also associated with Osteopoikilosis and Buschke-Ollendorff syndrome.

Question 2199

Topic: Biology, Genetics & Bone Healing

A 35-year-old patient presents with chronic, deep aching pain in the lower extremity and joint contractures. Radiographs demonstrate dense, irregular, eccentric hyperostosis along the cortex of the femur and tibia, resembling dripping candle wax. Mutations in which of the following genes are most commonly associated with this condition?

. GNAS1
. EXT2
. LEMD3
. SOX9
. RUNX2

Correct Answer & Explanation

. LEMD3

Explanation

Correct Answer: LEMD3The clinical and radiographic description is classic for melorheostosis, a rare sclerosing bone dysplasia characterized by anarchic hyperostosis that resembles 'dripping candle wax' or 'flowing wax' on radiographs. It typically affects one limb (monomelic) and can cause severe pain and joint contractures. Melorheostosis, along with osteopoikilosis and Buschke-Ollendorff syndrome, has been linked to loss-of-function mutations in the LEMD3 gene (also known as MAN1), which encodes an inner nuclear membrane protein that interacts with BMP and TGF-beta signaling pathways. GNAS1 is linked to fibrous dysplasia, EXT2 to multiple hereditary exostoses, SOX9 to campomelic dysplasia, and RUNX2 to cleidocranial dysplasia.

Question 2200

Topic: Biology, Genetics & Bone Healing

A 28-year-old female with polyostotic fibrous dysplasia complains of severe, persistent bone pain in her lower extremities that is refractory to NSAIDs. Radiographs show stable, ground-glass expansile lesions without impending fracture. Which of the following pharmacological interventions is most appropriate as the next step in management?

. Oral corticosteroids
. Subcutaneous teriparatide
. Intravenous bisphosphonates
. Intravenous antibiotics
. Oral methotrexate

Correct Answer & Explanation

. Intravenous bisphosphonates

Explanation

Correct Answer: Intravenous bisphosphonatesIn patients with fibrous dysplasia, bone pain is a common and debilitating symptom. When conservative measures like NSAIDs fail, intravenous bisphosphonates (such as pamidronate or zoledronic acid) are the pharmacological treatment of choice. Bisphosphonates inhibit osteoclastic bone resorption, which is upregulated in fibrous dysplasia lesions, thereby reducing bone turnover and significantly alleviating bone pain. They may also improve the radiographic appearance of the lesions in some cases. Teriparatide (an anabolic agent) is contraindicated as it stimulates bone turnover. Corticosteroids and methotrexate have no role in the management of fibrous dysplasia.

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