<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 69-year-old African American man is brought to the emergency department with sudden onset lower limb paralysis and back pain. He has had generalized bone pain for 2 months. He has no history of severe illnesses. He takes ibuprofen for pain. On examination, he is pale. The vital signs include: temperature 37.1C 98.8F, pulse 68min, respiratory rate 16min, and blood pressure 15590 mm Hg. The neurologic examination shows paraparesis. The 8th thoracic vertebra is tender to palpation. An X-ray of the thoracic vertebrae confirms a compression fracture at the same level. The laboratory studies show the following:Laboratory testHemoglobin 9 gdLMean corpuscular volume 95 μm3Leukocyte count 5,000mm3Platelet count 240,000mm3ESR 85 mmhourSerumNa 135 mEqLK 4.2 mEqLCl 113 mEqLHCO3 20 mEqLCa 11.5 mgdLAlbumin 4 gdLUrea nitrogen 18 mgdLCreatinine 1.2 mgdLSerum electrophoresis shows a monoclonal protein level of 38 gL. To reduce the likelihood of fracture recurrence, it is most appropriate to administer which of the following?? A: Calcitonin, B: Calcitriol, C: Fluoride, D: Pamidronate, E: Testosterone,  <response>: This is a clinical vignette describing a 69-year-old African American man with sudden onset lower limb paralysis, back pain, generalized bone pain, pale appearance, paraparesis, thoracic vertebrae tenderness and compression fracture, anemia, leukopenia, thrombocytopenia, elevated ESR, hypercalcemia, renal insufficiency, monoclonal gammopathy, and multiple myeloma. The key findings are multiple myeloma with associated vertebral compression fracture and hypercalcemia. The goal is to reduce the likelihood of fracture recurrence. Pamidronate is a bisphosphonate that inhibits osteoclast-mediated bone resorption and can reduce skeletal complications in multiple myeloma. It is the most appropriate choice to reduce fracture risk in this patient with multiple myeloma.Calcitonin can lower calcium levels but does not reduce fracture risk. Calcitriol increases intestinal calcium absorption and can worsen hypercalcemia. Fluoride may increase bone mass but is not used to prevent fractures in myeloma. Testosterone does not have a role in preventing fractures in multiple myeloma.D: Pamidronate 