<prompt> A 70 years old female is on treatment with Alendronate for 7 years for osteoporosis. Now she complains of pain in right thigh. What is the next investigation to be performed?DEXA scanX-raySerum vitamin D levelsSerum alkaline phosphate levels  <response>: Long term use of Alendronate Bisphosphonates results in following radiological changes in patients presenting with tigh pain: Earliest change would be thickening coex femur predominantly the lateral coex Later it results in subtrochanteric fracture through the thickened coex with medial spike. Hence in this scenario the next investigation would be X ray to see for coical thickening and atypical subtrochanteric fractures. 