Fracture Type

Question 1

Does FRAX over-estimate or under-estimate fracture probability in individuals with a parental history of non-hip fragility fracture?

Answer 1

Underestimates fracture probability

Question 2

Is a fragility fracture an indication for bone density testing?

Answer 2

Yes

Question 3

What is the definition of severe or established osteoporosis?

Answer 3

Bone density that is 2.5 standard deviations or more below the young-adult normal mean (T-score at or below -2.5) with at least one fragility fracture.

Question 4

Name a cause of primary osteoporosis in children that is a result of a genetic defect in collagen synthesis.

Answer 4

Osteogenesis imperfecta

Question 5

Which site in post-menopausal women does pQCT of the forearm predict fragility fracture at?

Answer 5

Hip

Not spine

Question 6

Which site in men does pQCT of the forearm predict fragility fracture at?

Answer 6

There is lack sufficient evidence to answer this question

Question 7

Which device predicts fragility fracture in post-menopausal women (hip, vertebral, and global fracture risk) and men over the age of 65 (hip and all non-vertebral fractures), independently of central DXA BMD?

Clue: validated skeletal site is the heel

Answer 7

QUS device

Question 8

Do validated pDXA devices have stronger or weaker vertebral fracture predictive ability in post-menopausal women than central DXA and heel QUS?

Answer 8

Weaker

Question 9

Can measurement by validated pDXA devices be used to assess vertebral and global fracture risk in post-menopausal women?

Answer 9

Yes

Question 10

Can measurement by validated pDXA devices be used to assess vertebral and global fracture risk in men?

Answer 10

There is lack of sufficient evidence to support this position in men.

Question 11

Have FDA-approved osteoporosis treatments been shown to decrease fracture risk in patients who have had fragility fractures?

Answer 11

Yes

Question 12

Teriparatide reduces the risk of non-vertebral fragility fractures by about ____ % in patients with osteoporosis, after an average of ____ months of therapy.

Answer 12

53%

18 months

Question 13

What is the advantage of bone density measurement compared to standard x-ray radiographs?

Answer 13

Patients at high risk of fragility fractures are frequently identified earlier in the disease, before changes appear on standard x-rays.

Question 14

The lower a patient’s T-score, the more likely that a fragility fracture will occur.

True or false?

Answer 14

True

Question 15

What does osteoporosis do via micro-architectural changes in bone?

Answer 15

Increases the risk of fragility fractures

Question 16

Do patients with bone density T-scores better than -2.5 have a lower risk of fragility fractures?

Answer 16

Yes

Question 17

What is a fragility fracture?

Answer 17

An osteoporotic fracture or low-trauma fracture that occurs with a force less than or equal to falling from a standing position.

(fracture following minimal trauma)

Question 18

Presence of fragility fracture defines osteoporosis regardless of the T-score.

True or false?

Answer 18

True

Question 19

Are T-scores alone adequate to predict the risk for fragility fractures?

Answer 19

No

Question 20

Should you diagnosis osteoporosis in younger patients based on their T-scores?

Answer 20

No

Question 21

Are patients with inflammatory bowel disease or celiac disease at increased risk of osteoporosis and fragility fractures?

Answer 21

Yes

Question 22

Is obesity protective against development of osteoporosis?

Answer 22

No

Question 23

What does diabetes mellitus type 2 do to the risk of osteoporosis and fragility fracture?

Answer 23

Increases it

Question 24

Some medications used to lower blood glucose in type 2 diabetes mellitus significantly increase the risk of osteoporosis and fragility fracture.

True or false?

Answer 24

True

Question 25

What is a Colles’ fracture?

Answer 25

A common fragility fracture of the distal radius that occurs when a person falls on their outstretched arm.

Traverse fracture with dorsal displacement and angulation.

Question 26

A parental history of non-hip fragility fracture may be a risk factor for fracture.

True or false?

Answer 26

True

Question 27

Is a fragility fracture an indication for bone density testing?

Answer 27

Yes

Question 28

Does pQCT of the forearm at the ultra-distal radius predict fragility fractures at the spine in post-menopausal women?

Answer 28

No

Question 29

Do validated heel QUS devices predict fragility fractures in men over 65 years of age independently of central DXA BMD?

Answer 29

Yes

Question 30

Do validated pDXA devices have stronger or weaker global fragility fracture predictive ability in post-menopausal women than central DXA and heel QUS?

Answer 30

Only vertebral fracture predictive ability is weaker

Question 31

Does a BMC/BMD Z-score of higher than -2.0 in children preclude the possibility of skeletal fragility and increased fracture risk?

Answer 31

No - it does not

Question 32

Typically how many years of bisphosphonate use is associated with low trauma atypical femur fractures?

Answer 32

More than 5 years

Question 33

What imaging studies should be ordered when an atypical femur fracture is suspected?

Answer 33

Bilateral x-ray of the femurs with suspected atypical femur fracture, followed by an MRI or radionucleotide bone scan when clinical suspicion is high enough

Question 34

What should you do with the bisphosphonates once an atypical femur fracture has occurred?

Answer 34

Stop the bisphosphonates

Question 35

Has denosumab been associated with atypical femur fractures?

Answer 35

Yes - rarely

Question 36

What are atypical femur fractures?

Answer 36

Low or no trauma fractures which are characterised by distinct radiologic and clinical features that are associated with long term use of potent anti-resorptive medications (distinguished from ordinary osteoporotic femoral diaphyseal fractures)

Question 37

What are the distinct radiographic findings in atypical femur fractures?

Answer 37

• transverse fracture line
• periosteal callus formation at the fracture site
• little or no comminution

Question 38

What are the distinct clinical features in atypical femur fractures?

Answer 38

• prodromal pain
• bilaterality
• resemble stress fractures