Osteoporosis

Question 1

This is defined as a softening of the bones d/t severe lack of vitamin D.

a. osteomalacia
b. osteopenia
c. osteoporosis
d. osteitis fibrosa

Answer 1

a. osteomalacia

Question 2

This is defined as low/normal bone density that is not low enough to be osteoporosis.

a. osteomalacia
b. osteopenia
c. osteoporosis
d. osteitis fibrosa

Answer 2

b. osteopenia

Question 3

What T score defines osteopenia?

Answer 3

T score between -1 and -2.5

Question 4

This is defined as a skeletal disorder causing compromised bone strength and quality.

a. osteomalacia
b. osteopenia
c. osteoporosis
d. osteitis fibrosa

Answer 4

c. osteoporosis

Question 5

What T score defines osteoporosis?

Answer 5

< 2.5

Question 6

This is defined as a deterioration of bone mass unassociated with other chronic illness

a. primary osteoporosis
b. secondary osteoporosis
c. severe osteoporosis

Answer 6

a. primary osteoporosis

Question 7

This is defined as deterioration of bone mass associated with chronic conditions that contribute significantly to accelerated bone loss.

a. primary osteoporosis
b. secondary osteoporosis
c. severe osteoporosis

Answer 7

b. secondary osteoporosis

Question 8

This is defined by a fragility fracture AND T score of < 2.5

Answer 8

c. severe osteoporosis

Question 9

This is defined as a softening and deformity of bones due to complications of hyperparathyroidism.

a. osteomalacia
b. osteopenia
c. osteoporosis
d. osteitis fibrosa

Answer 9

d. osteitis fibrosa

Question 10

What is the most common chief complaint associated with osteoporosis?

Answer 10

they are ASYMPTOMATIC until fracture

trick question

Question 11

A patient presents with a fragility fracture what else do you need to make the diagnosis of osteoporosis?

a. vitamin D labs
b. DEXA scan
c. FRAX score
d. the fragility fracture itself is diagnostic

Answer 11

d. the fragility fracture itself is diagnostic

Question 12

All women > ____ and all men > ____ should be screened for osteoporosis with a DEXA scan.

Answer 12

women > 65

men > 70

Question 13

Which of the following populations should NOT be screened for osteoporosis?

a. postmenopausal women <65
b. perimenopausal women
c. men 50-69 with clinical risk factors for a fracture
d. any adult with fracture after age of 40
e. any adult with risk factors assoc with low bone mass or bone loss (e.g. RA or steroid use)

Answer 13

d. any adult with fracture after age of 40

* after age of 50*

Question 14

What are the 4 lifestyle changes you would encourage to all patients with osteoporosis?

Answer 14

• diet
• regular weight bearing exercise
• smoking cessation
• avoid excess alcohol intake

Question 15

Pharmacologic therapy to reduce fracture risk is initiated in all of the following populations EXCEPT:

a. postmenopausal women and men >50 with hip or vertebral fracture
b. postmenopausal women and men >50 with T score < -2.5 at femoral neck, total hip or lumbar spine by DEXA
c. patients taking long term glucocorticoids
d. men with prostate cancer receiving androgen deprivation therapy who have high risk of fracture
e. pharmacologic therapy is indicated for all of these

Answer 15

e. pharmacologic therapy is indicated for all of these

Question 16

What is the first line pharmacologic therapy for osteoporosis?

Answer 16

oral bisphosphonates (e.g. Alendronate)

anything that ends in NATE

Question 17

Why are oral bisphosphonates first line therapy?

Answer 17

they reduce pain and suffering!

Question 18

What is the treatment protocol for oral bisphosphonates?

Answer 18

• treat for 5 years, then an UNCLEAR duration of “bisphosphonate holiday”
• monitor BMD with DEXA every 1-2 years*

Question 19

What are the adverse effects of oral bisphosphonates?

Answer 19

• esophagitis
• MSK pain
• osteonecrosis of jaw (rare)
• atypical femur fracture (rare)

Question 20

What is the FRAX score used for?

Answer 20

predicts 10 year fracture risk via calculator

Question 21

What are the general treatment guidelines for osteoporosis? (4 points)

Answer 21

• calcium 1200mg/day
• vitamin D 600 U/day
• weight bearing exercise
• avoid smoking/alcohol

Question 22

Vitamin ____ deficiency and heavy _______ consumption are common secondary causes of decreased BMD and osteoporosis.

Answer 22

• Vitamin D deficiency

- heavy alcohol consumption

Question 23

What is the diagnostic test of choice for both screening and diagnosis of osteoporosis and osteopenia?

Answer 23

DEXA scan

Question 24

It is universally recommended to supplement with ________ for the prevention and treatment of osteoporosis in postmenopausal women

Answer 24

calcium

*vitamin D supplementation remains controversial