404 Osteoporosis

Question 1

Final common path in osteoclast development and activation

Answer 1

Activation of RANK by RANKL

Question 2

WHO operational definition of osteoporosis

Answer 2

T score of - 2.5

Question 3

Cytokine responsible for communication between osteoblast, other marrow cells and osteoclast

Answer 3

RANK ligand

Question 4

Stimulates bone formation by increasing the activity of osteoclast and decrease RANKL secretion

Answer 4

Wnt signaling pathway

Question 5

Recommended daily requirement of calcium

Answer 5

1000-1200 mg

Question 6

Targets of serum 25OHD for optimal skeletal health

Answer 6

More than 75 nmol/L or 30 ng/ml

Question 7

Important risk factor for osteoporosis and fractures

Answer 7

Vitamin D insufficiency

Question 8

Mechanism estrogen deficiency leads to bone loss

Answer 8

1. Activation of remodeling sites

2. Exaggeration of imbalance between bone formation and resoprtion

Question 9

Most common estrogen-deficiency state

Answer 9

Cessation of ovarian function at time of menopause

Question 10

How does estrogen play a role in bone cells

Answer 10

Estrogen can control rate of apoptosis. In estrogen deprivation, life span of osteoblast is decreased and osteoclast in increased

Question 11

Comprises 80% of bone surface area

Answer 11

Trabecular bone

Question 12

Which has a small surface area: trabecular or cortical bone

Answer 12

Cortical

Question 13

In osteoporosis, where does fracture open occur earliest

Answer 13

Where trabecular bone contributes most to bone strength

Question 14

Most common early skeletal consequence of estrogen deficiency

Answer 14

Vertebral fractures

Question 15

Most common causes of medication induced osteoporosis

Answer 15

Glucocorticoids

Question 16

Highly accurate x ray technique that is the standard for measuring bone density

Answer 16

DXA

Question 17

Preferred site for measurement of bone mineral densitt

Answer 17

Hip

Question 18

Alternative area to measure bone mineral density when spine or hip is not measurable

Answer 18

Wrist

Question 19

At what age is bone mineral density testing recommend to all women

Answer 19

Age 65 for females

Age 70 for males

Question 20

When is a patient on glucocorticoids advised BMD testing

Answer 20

Prednisone more than 5 mg per day or equivalent for more than 3 months

Question 21

In presence of hypercalcemia, how to differentiate Hyperparathyroidism and hypercalcemia of malignancy

Answer 21

Get serum PTH. Hyperparathyroidism has elevated PTH while hypercalcemia of malignancy has low PTH and high PTHrp

Question 22

Suggested by low urine calcium

Answer 22

Malnutrition and malabsorption

Question 23

High urine calcium of how much points to hypercalciuria

Answer 23

Urine calcium more than 300 mg/24 hours

Question 24

When does hypercalciuria occur

Answer 24

1. Renal calcium leak
2. Absorptive hypercalciuria which can be idiopathic or increased 1,24 OH2D in granulomatous disease
3. Hematolofic malignancies associated with excessive bone turnover

Question 25

Treament of renal hypercalciuria

Answer 25

Thiazide diuretics

Question 26

Primary use of biochemical marker

Answer 26

Monitoring response to treatment

Question 27

Most sensitive biochemical marker for bone formation

Answer 27

P1NP

Question 28

When is bone resoprtion measurement done

Answer 28

CTX is done prior to initiating treament and 3-6 months

Question 29

Only currently approved anabolic agent

Answer 29

Teriparatide

Question 30

General pharmacologic therapies for osteoporosis

Answer 30

Antiresorptive

Anabolic

Question 31

Given in combination with estrogen to reduce risk of uterine cancer

Answer 31

Progestin (daily or cyclic at least 12 days per month)

Question 32

Two SERMS approved for use for postmenopausal women for osteoporosis

Answer 32

Tamoxifen

Raloxifene

Question 33

Dosage of alendronate for osteoporosis and for prevention

Answer 33

10 mg/day for osteoporosis

5 mg/day for prevention

Question 34

GFR when biphosphonates contraindicated

Answer 34

GFR less than 30-35 ml/min

Question 35

Two potential side effects of biphosphonates

Answer 35

Osteonecrosis of the jaw

Atypical femoral fracture

Question 36

Calcitonin is approved for what diseases

Answer 36

Pagets disease
Hypercalcemia
Osteoporosis in women more than 5 years past menopause

Question 37

Mode of action of calcitonin

Answer 37

Suppress osteoclast activity by direct action on osteoclast calcitonin receptor

Question 38

Humanized antibody that blocks osteocyte production of sclerostin resulting in increased bone formation and define in bone resoprtion

Answer 38

Romosozumab