Osteoporosis

Question 1

Osteoporosis refers to weak and porous bones due to low bone mineral density. This is the most common metabolic bone disease. The fractures that are due to osteoporosis can be divided into which of the 2 categories below?

1 - trauma and pathological (diseased bone)
2 - trauma and accidental
3 - pathological and physiological
4 - pathological and accidental

Answer 1

1 - trauma and pathological (diseased bone)

• patients with osteoporosis commonly have fragility fractures

Question 2

Patients with osteoporosis are said to have fragility fractures, which are fractures sustained through low energy trauma, such as a fall from standing height of less. What are the 4 most common sites for fractures in osteoporosis

1 - PIP, DIP, proximal humerus and spine
2 - proximal humerus, hip/neck of the femur, spine, forearm
3 - proximal humerus, hip/neck of the femur, femur, forearm
4 - ankle, hip/neck of the femur, spine, forearm

Answer 2

1 - proximal humerus
2 - hip/neck of the femur
3 - spine
4 - forearm

Question 3

How can we diagnose osteoporosis?

1 - DEXA
2 - X-ray
3 - MRI
4 - ultrasound

Answer 3

1 - DEXA

Question 4

Bone mineral density is the amount of bone contained with a unique area, which can only be quantified using a DEXA scanner. The DEXA scanner can generate a T score, what is a T score?

1 - score for patients BMD compared to peak of a 30 y/o female
2 - score for patients BMD compared against same gender and age
3 - score for patients BMD compared to peak of a 30 y/o male
4 - score for patients BMD compared against same age

Answer 4

1 - score for patients BMD compared to peak of a 30 y/o female

• patients BMD is converted to a T score to standardise BMD scores
• t score is then compared to the peak of a 30 y/ol female as SD either side of peak female T score

Question 5

What is osteopenia?

Question 6

Osteopenia is less severe form of osteoporosis. Using the DEXA what is the diagnosis of osteopenia?

• a normal DEXA T score is > -1

1 - -1 to -2.5
2 - < -2.5
3 - < -2.5 with at least one fracture
4 - >-1

Answer 6

1 = -1 to -2.5

• < -2.5 = osteoporosis
• < -2.5 with at least one fracture = severe osteoporosis

Question 7

What proportion of >65 will fall in a year, and thus increase the risk of fractures?

1 - 33%
2 - 50%
3 - 70%
4 - 100%

Answer 7

1 - 33%

Question 8

What is the single most important risk fracture for a fragility fractures?

1 - exercise
2 - diet
3 - gender
4 - age

Answer 8

4 - age

Question 9

What % of adult women will have one or more fragility fracture in their lifetime?

1 - 15%
2 - 25%
3 - 50%
4 - 80%

Answer 9

3 - 50%
- 20% in men
- 549,000 new fragility each year in the UK

Question 10

What is the most common fragility fracture?

1 - vertebral
2 - hip
3 - femur
4 - radius

Answer 10

1 - vertebral
- 70% go undiagnosed as they as asymptomatic

Question 11

What is the most common fracture in young patients?

1 - vertebral
2 - hip
3 - femur
4 - radius

Answer 11

4 - radius
- forearm (distal radius) fracture from falling over

- older = hips (fall directly onto the hips)

Question 12

What is the most common fracture in older patients?

1 - vertebral
2 - hip
3 - femur
4 - radius

Answer 12

2 - hips
- fragility fractures account for 105,000 hip fractures/year in the UK

Question 13

What is an index fracture?

1 - risk of subsequent fractures following an initial fracture
2 - risk of 1st fractures
3 - risk of developing multipole fractures simultaneously

Answer 13

1 - risk of subsequent fractures following an initial fracture

Question 14

What % of patients will die within 12 months of a hip fracture?

1 - 10-15%
2 - 15-20%
3 - 25-30%
4 -30-40%

Answer 14

3 - 25-30%

Question 15

Which of the following patients does NOT need to be assessed for frailty fracture risk?

1 - women aged ?65 years and over, and
2 - men aged >75 years
3 - women aged 50–64 and men aged 50–74 with the risk factors
4 - women <50y/o with a fracture

Answer 15

4 - women <50y/o with a fracture

Risk factors used to identify those that need to be assessed for frailty fracture risk include:

• previous osteoporotic fragility fracture
• corticosteroids use
• history of falls
• low BMI(less than18.5kg/m2)
• smoker
• alcoholintake >14 units per week
• secondary cause of osteoporosis

Question 16

Is the mortality higher in patients following a hip or vertebral fracture?

Answer 16

• vertebral
• number of vertebral fractures increases mortality
• thoracolumbar part of spine is most common

Question 17

What are some common signs of a vertebral fracture?

1 - pain, height loss and hearing changes
2 - pain, height loss and change in posture
3 - height loss and change in posture
4 - height loss and change in posture

Answer 17

2 - pain, height loss and change in posture

• pain is from compressed nerves
• posture and height loss are due to damaged vertebrae creating a wedged vertebrae

Question 18

We all have a degree of lordosis (outward curvature of the spine) and kyphosis (inward curvature of the spine) in a normal and healthy spine. Which segments of the vertebral spine are lordosis and kyphosis in normal spine?

1 - cervical and lumber = lordosis and thoracic = kyphosis
2- cervical and lumber = kyphosis and thoracic = lordosis
3 - cervical and thoracic = lordosis and lumbar = kyphosis
4 - thoracic and lumber = lordosis and cervical = kyphosis

Answer 18

1 - cervical and lumber = lordosis and thoracic = kyphosis

Question 19

At what age does bone mass peak in our lifetime?

1 - 10-15 y/o
2 - 15-20 y/o
3 - 20-25 y/o
4 - 28-30 y/o

Answer 19

4 - 28-30 y/o

Question 20

Is bone mineral mass affected by genetics?

Answer 20

• yes
• polygenic up to aprox 50-70%

Question 21

What is key in terms of lifetime bone mass that we can modify?

1 - medications
2 - employment
3 - lifestyle through diet and exercise
4 - low alcohol and drug use

Answer 21

3 - lifestyle through diet and exercise

Question 22

What are the key 2 key micronutrients that are essential for bone health?

1 - Ca2+ and Vitamin A
2 - Ca2+ and Vitamin K
3 - Folic Acid and Vitamin D
4 - Ca2+ and Vitamin D

Answer 22

4 - Ca2+ and Vitamin D
Protein
Micronutrients: Vitamin A, B Vitamins, Vitamin K, Magnesium and Zinc

Question 23

99% of the bodies Ca2+is maintained within bones. But 1% is found within serum, Why is serum Ca2+ a bad marker for assessing overall Ca2+ absorption and consumption?

1 - slow to respond to pathology
2 - will be normal even if patient has osteoporosis
3 - assays have poor sensitivity
4 - assays have poor specificity

Answer 23

2 - will be normal even if patient has osteoporosis

• even if patient has osteoporosis, PTH will ensure serum Ca2+ is maintained from bones stores
• need to measure Ca2+ and hormone levels as PTH could be high in osteoporosis

Question 24

What is the recommended intake of Ca2+?

1 - 100mg
2 - 1500mg
3 - >1000mg
4 - >3000mg

Answer 24

3 - >1000mg

Question 25

In addition to dairy, which of the following is NOT a good sources of Ca2+?

1 - nuts (almonds)
2 - bread
3 - broccoli
4 - spinach
5 - dairy substitutes

Answer 25

2 - bread

Question 26

What is the most commonly prescribed for patients with low bone mineral density?

1 - magnesium and Ca2+
2 - zinc and vitamin D3
3 - Ca2+ with vitamin D3
4 - Ca2+ and zinc

Answer 26

3 - Ca2+ with vitamin D3
- D3 important for bone health

Question 27

What % of vitamin D is absorbed through sunlight?

1 - 10%
2 - 30%
3 - 55%
4 - 95%

Answer 27

4 - 95%

Question 28

Order the process of how vitamin D is process to make active vitamin D using the labels below:

• converted to 1, 25 hydroxyvitamin D (active vitamin D)
• converted into calcifediol (25-hydroxycholecalciferol) in the liver
• vitamin D3 or D2 absorbed through skin or diet, respectively

Answer 28

1st - vitamin D3 or D2 absorbed through skin or diet, respectively
2nd - converted into calcifediol (25-hydroxycholecalciferol) in the liver
3rd - converted to 1, 25 hydroxyvitamin D (active vitamin D)

Question 29

What effect does vitamin D have on GIT and bone?

1 - increases vitamin D absorption in GIT
2 - increases bile secretion to ensure absorption
3 - increases Ca2+ absorption from enterocytes in GIT
4 - all of the above

Answer 29

3 - increases Ca2+ absorption from enterocytes in GIT
- mobilises Ca2+ stores by acting like PTH

Question 30

What affect can chronic liver disease affect vitamin D?

1 - increaeses PTH levels in the blood
2 - decreases conversion of vitamin D3 and D2 into 25 hydroxyvitamin
3 - increases conversion of vitamin D3 and D2 into 25 hydroxyvitamin
4 - reduces PTH levels in the blood

Answer 30

2 - decreases conversion of vitamin D3 and D2 into 25 hydroxyvitamin
- so active vitamin D is not created

Question 31

What affect can obesity affect vitamin D?

1 - increaeses PTH levels in the blood
2 - increases vitamin D absorption as larger surface area exposes to sun
3 - impairs skins ability to absorb vitamin D
4 - reduces PTH levels in the blood

Answer 31

3 - impairs skins ability to absorb vitamin D

Question 32

Can medications such as long term use of anti-epileptics or retrovirals affect vitamin D levels?

Answer 32

• yes
• impairs vitamin D synthesis

Question 33

What affect can chronic kidney disease affect vitamin D?

1 - D1 - cannot reabsorb Ca2+ or convert 25 hydroxyvitamin D into 1,25 hydroxyvitamin D, the active form of vitamin
2 - increases vitamin D absorption as larger surface area exposes to sun
3 - impairs skins ability to absorb vitamin D
4 - rincreases Ca2+ re-absorption causing hypercalcaemia

Answer 33

1 - D1 - cannot reabsorb Ca2+ or convert 25 hydroxyvitamin D into 1,25 hydroxyvitamin D, the active form of vitamin

Question 34

Protein is important for bone health, why is this?

1 - amino acids are essential for bone matrix
2 - amino acids stimulate muscle growth and bone development
3 - amino acids are raised in puberty
4 - amino acids are released stimulating RANK-L release in bone

Answer 34

1 - amino acids are essential for bone matrix

Question 35

What affect does vitamin K have on bone health?

1 - crucial for making osteocalcin which is secreted by osteoclasts
2 - crucial for making osteocalcin which is secreted by osteoblasts
3 - crucial for making osteocalcin which is important in the conversion of active Vitamin D
4 - all of the above

Answer 35

1 - crucial for making osteocalcin which is secreted by osteoclasts

Question 36

What effect does magnesium have on bone health?

1 - inhibits osteoblasts proliferation
2 - stimulates osteoclasts proliferation
3 - stimulates osteocyte proliferation
4 - stimulates osteoblasts proliferation

Answer 36

4 - stimulates osteoblasts proliferation
- osteoblasts build new bone

Question 37

What effect does zinc have on bone health?

1 - involved in bone deposition
2 - involved in osteoblasts development
3 - involved in osteoclasts development
4 - involved in bone mineralisation

Answer 37

4 - involved in bone mineralisation

Question 38

How does a low BMI (<19) affect bone health in a woman?

1 - low vitamin D intake
2 - amenorrhea so no progesterone
3 - amenorrhea so no estrogen
4 - low Ca2+ intake

Answer 38

3 - amenorrhea so no estrogen

• oestrogen inhibits osteoclasts, if low estrogen then there will be high breakdown of bone that is not matched by osteoblast activity
• also poor diet and reduced weight so reduced mechanical stress

Question 39

How does alcohol affect bone density?

1 - reduces hormones (testosterone and estrogen)
2 - impairs vitamin D metabolism
3 - impairs Ca2+ absorption
4 - inhibits osteoblasts

Answer 39

1 - reduces hormones (testosterone and estrogen)
- suppresses osteoblasts differentiation
- estorgen inhibits osteoclasts, so will get high bone turnover
- increases falls and fracture risk

Question 40

The cumulative risk of bone fracture is dependent on what in smoking?

1 - amount smoked
2 - duration of smoking
3 - what is smoked
4 - amount and duration of smoking

Answer 40

4 - amount and duration of smoking

Question 41

How much exercise should be done weekly and daily in an attempt to maintain bone mass?

1 - 10 minutes a day/70 minutes/week
2 - 30 minutes a day/120 minutes/week
3 - 60 minutes a day/150 minutes/week
4 - 90 minutes a day/360 minutes/week

Answer 41

3 - 60 minutes a day/150 minutes/week

Question 42

How does inflammatory disease, which has increased levels of TNF-a, IL-6 and IL-1 affect the risk of osteoporosis?

1 - inhibits osteoblasts
2 - increases osteoblast activity
3 - decreases Ca2+ absorption
4 - decreases conversion of active vitamin D

Answer 42

1 - inhibits osteoblasts
- increase RANK-L and activate osteoclasts activity
- results in increased bone breakdown that is not matched by osteoblast activity

Question 43

What is the FRAX tool?

Answer 43

• algorithm for the risk of fracture over 10 years

Question 44

Before a fracture occurs, what are the common signs of osteoporosis?

1 - sore bones
2 - weak muscles
3 - no symptoms
4 - history of fractures

Answer 44

3 - no symptoms

Question 45

Once an osteoporotic woman has had a 1st vertebral fracture, what % of the these women are likely to have another vertebral fracture within the next 12 months?

1 - 5%
2 - 10%
3 - 19%
4 - 33%

Answer 45

3 - 19%

Question 46

Fragility vertebral fractures can cause kyphosis, which is an abnormal rounding of the spine. What happens to the patients centre of gravity and what can this lead to?

1 - centre of gravity moves horizontally (backwards) increasing the risk of falls
2 - centre of gravity moves horizontally (backwards) increasing the risk of fractures
3 - centre of gravity moves horizontally (forwards) increasing the risk of falls
4 - centre of gravity moves horizontally (forwards) increasing the risk of fractures

Answer 46

2 - centre of gravity moves horizontally (backwards) increasing the risk of fractures

Question 47

How many units of alcohol p/w doubles the risk of bone fracture?

1 - 1 unit
2 - 1-2 units
3 - 3-4 units
4 - >4 units

Answer 47

3 - 3-4 units

Question 48

Glucocorticoids have been linked with osteoporosis, which of the following is NOT linked with Glucocorticoids?

1 - Increased PTH secretion
2 - Reduced Ca2+ reabsorption in kidneys
3 - Reduced oestrogen
4 - Impaired Vit D absorption
5 - Acute suppression of osteoblasts
6 - Stimulation of osteoclastogenesis

Answer 48

2 - Reduced Ca2+ reabsorption in kidneys

Question 49

A 50 year old lady was referred to the RA clinic. She had the following on a medical history:

• Family history maternal hip fracture
• Coeliac Disease – strict gluten-free adherence
• Lactose Intolerance
• Family history breast cancer
• Last menstrual period 49 yrs
• Well, regular weight-bearing exercise
• No history of falls
• Never fractured
• Never smoked
• Alcohol 6U/wk
• BMI 17.31
• paracetamol
• no history of corticosteroids or PPIs

Which of the above factors are risk factors for osteoporosis?

Answer 49

• Family history maternal hip fracture = high genetic association
• Coeliac Disease – strict gluten-free adherence (poor Ca2+ absorption)
• Lactose Intolerance (low Ca2+ intake)
• Low BMI (high risk amenorrhea and low mechanical loading)

Question 50

A 50 year old lady was referred to the RA clinic. She had the following on a medical history:

• Family history maternal hip fracture
• Coeliac Disease – strict gluten-free adherence
• Lactose Intolerance
• Family history breast cancer
• Last menstrual period 49 yrs
• Well, regular weight-bearing exercise
• No history of falls
• Never fractured
• Never smoked
• Alcohol 6U/wk
• BMI 17.31
• paracetamol
• no history of corticosteroids or PPIs

This patient then has a DEXA, which gives a T score of -2.1. What does this score mean?

Answer 50

• patient is osteopenic
  -1 to -2.5 = osteopenic
  < -2.5 osteoporosis
  < -2.5 with at least one fracture severe osteoporosis

Question 51

What is the goal of any treatment for osteoporosis?

Answer 51

• fragility fracture prevention

Question 52

When we look at modifying patients lifestyle we need to reduce or stop known risk factors for RA. What are the 3 lifestyle factors, excluding diet that need modifying?

1 - smoking, alcohol, exercise
2 - medication, alcohol, exercise
3 - smoking, sleep, exercise
4 - sleep, alcohol, exercise

Answer 52

1 - smoking, alcohol, exercise
- smoking = stop smoking
- alcohol = reduce alcohol <4u/wk
exercise = encourage weight bearing exercise

Question 53

When we look at modifying patients lifestyle we need to reduce or stop known risk factors for osteoporosis. What are the 2 most important dietary changes that should be addressed?

1 - vitamin D and A supplements
2 - vitamin D and B12 supplements
3 - vitamin B12 and Ca2+ supplements
4 - vitamin D and Ca2+ supplements

Answer 53

4 - vitamin D and Ca2+ supplements
- vitamin D supplementation (1000-2000 IU colecalciferol/day)
- Ca2+ if levels are low: 700-1200mg

Question 54

Which cell within bones is responsible for mechanotransduction in bones, which is the mechanism by which cells convert mechanical stimuli into cellular responses to a variety of mechanical loads?

1 - osteons
2 - osteoclasts
3 - osteoblasts
4 - osteocytes

Answer 54

4 - osteocytes

Question 55

When deciding on which patients to treat who may have osteoporosis, which scoring tool is used?

1 - National Osteoporosis Guideline Group (NOGG) guidelines
2 - royal college of geriatricians guidelines
3 - GP guidelines
4 - all of the above

Answer 55

1 - National Osteoporosis Guideline Group (NOGG) guidelines

Question 56

There are only 2 ways that any osteotherapy drugs are able to target bones, what are they?

1 - inhibit osteoblasts and stimulate osteoclasts
2 - inhibit osteoblasts and osteoclasts
3 - stimulate osteoblasts and inhibit osteoclasts
4 - stimulate osteoblasts and osteoclasts

Answer 56

3 - stimulate osteoblasts and inhibit osteoclasts

Question 57

When we talk about osteotherapy drugs we talk about antiresorptive and anabolic. What does antiresorptive mean?

1 - inhibit reabsorption of bone
2 - inhibit forming of new bone
3 - inhibit reabsorption of Ca2+
3 - increase reabsorption of Ca2+

Answer 57

1 - inhibit reabsorption of bone
- essentially targets osteoclasts

Question 58

When we talk about osteotherapy drugs we talk about antiresorptive and anabolic. What does anabolic mean?

1 - inhibit reabsorption of bone
2 - accentuate forming of new bone
3 - inhibit reabsorption of Ca2+
3 - increase reabsorption of Ca2+

Answer 58

2 - accentuate forming of new bone
- anabolic = building, in this instance its bone rebuilding

Question 59

If a clinician is considering prescribing hormone replacement therapy, specifically oestrogen for a female patient with osteoporosis, what must they ensure prior to prescribing them oestrogen?

1 - cervical cancer
2 - breast cancer
3 - osteosarcoma
4 - hepatocarcinoma

Answer 59

2 - breast cancer
- oestrogen receptor positive breast cancer can increase the risk of breast cancer, so we wouldn’t want to give this patient oestrogen

Question 60

What are selective oestrogen receptor modulator medication that can be given to patients with osteoporosis?

1 - drugs that regulate non-estrogen receptors
2 - drugs that regulate all estrogen receptors
3 - drugs that regulate estrogen receptors on breast tissue only
4 - drugs that regulate estrogen receptors on bones only

Answer 60

2 - drugs that regulate all estrogen receptors
- inhibits/down regulates osteoclast activity

Question 61

Selective oestrogen receptor modulator medication can be given to patients with osteoporosis, which are drugs that act on estrogen receptors. For example in bone they inhibits/down regulates osteoclast activity. Which of the following is the drug commonly used in the UK?

1 - Methotrexate
2 - Tamoxifen
3 - Raloxifene
4 - Prednisolone

Answer 61

3 - Raloxifene

Question 62

Selective oestrogen receptor modulator medication can be given to patients with osteoporosis, which are drugs that act on estrogen receptors. For example in bone they inhibits/down regulates osteoclast activity, with Raloxifene being the key drug used in the UK. Although effective at reducing the risk of vertebral fracture, what are the most common adverse events that can occur with this drug?

1 - heart attack and strokes
2 - stroke and deep vein thrombosis
3 - stroke and breast cancer
4 - breast cancer and deep vein thrombosis

Answer 62

2 - stroke and deep vein thrombosis

Question 63

If you have a patient that has previously had a fracture, is hormone therapy (HRT or Selective Oestrogen Receptor Modulators) going to be potent enough for treatment?

Answer 63

• no

Question 64

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. What is the 1st line treatment for patients who have previously had a fracture?

1 - antibiotics
2 - steroids
3 - bisphosphonates
4 - RANK-L medication

Answer 64

3 - bisphosphonates

Question 65

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. Which of the following is NOT one of the the 3 drugs we need to know?

1 - Alendronic acid
2 - Disodium pamidronate
3 - Zolendronic acid
4 - Amiodarone

Answer 65

4 - Amiodarone
- class III anti-arrhythmic medication through K+ channel inhibition

Question 66

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. The 3 drugs we need to know are:

1 - Alendronic acid
2 - Disodium pamidronate
3 - Zolendronic acid

What is the basic mechanism of action of this group of drugs?

1 - induce osteoblast proliferation
2 - induce osteocyte proliferation
3 - induce osteoblast apoptosis
4 - induce osteoclasts apoptosis

Answer 66

4 - induce osteoclasts apoptosis

• bisphosphonates have a similar structure to inorganic pyrophosphate
• bisphosphonates are incorporated into bone matrix
• bisphosphonates accumulates in osteoclasts and inhibits inhibit Farnesyl Pyrophosphate Synthase (FPS)
• FPSinhibition induces apoptosis of osteoclasts

Question 67

What is paget’s disease?

Answer 67

• disease of bone
• interferes with bones normal recycling process
• bones become fragile and misshapen

Question 68

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. The 3 drugs we need to know are:

1 - Alendronic acid
2 - Disodium pamidronate
3 - Zolendronic acid

These drugs essentially cause apoptosis of osteoclasts. Which of the following diseases have these medications NOT been licensed for?

1 - hypercalcaemia of malignancy
2 - metastatic bone cancer
3 - active pagets disease
4 - acute kidney injury
5 - osteoporosis

Answer 68

4 - acute kidney injury

Question 69

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. The 3 drugs we need to know are:

1 - Alendronic acid
2 - Disodium pamidronate
3 - Zolendronic acid

These drugs must be taken in a very specific way. How must they be taken?

Answer 69

• taken once a week in the morning
• on a empty stomach with a full glass of water standing up
• must not eat for 30 minutes

Question 70

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates, with the 3 core drugs being Alendronic acid, Disodium pamidronate and Zolendronic acid. What is the most common side effect of these drugs?

1 - rickets disease
2 - oesophagitis/gastritis (oral agents)
3 - osteonecrosis of the jaw (rare)
4 - atypical femoral fractures (rare)

Answer 70

2 - oesophagitis/gastritis (oral agents)

Question 71

If you have a patient that has previously had a fracture, hormone therapy (HRT or Selective Oestrogen Receptor Modulators) is not going to be potent enough for treatment. The 1st line treatment for patients who have previously had a fracture is bisphosphonates. The 3 drugs we need to know are:

1 - Alendronic acid
2 - Disodium pamidronate
3 - Zolendronic acid

Which of the following is NOT a key contraindications for these drugs?

1 - renal impairment as excreted by kidneys
2 - hypocalcaemia
3 - Hypothyroidism
4 - upper gastrointestinal pathology eg peptic ulcer disease
5 - dental disease

Answer 71

3 - Hypothyroidism

Question 72

RANK-L is a protein that is a member of the protein family TNF-a, a cytokine. Which cells secrete RANK-L?

1 - osteoclasts
2 - neutrophils
3 - osteoblasts
4 - macrophages

Answer 72

3 - osteoblasts
- RANK-L binds to RANK-L recepotors on precursor monocytes
- precursor monocytes fuse together and form osteoclasts
- RANK-L also helps osteoclast mature

Question 73

Osteoprotegerin is a inhibitory factor released by osteoblasts. What is the function of osteoprotegerin?

1 - binds osteoblasts and inhibits RANK-L production
2 - binds with osteocytes and inhibits bone remodelling
3 - binds with RANK-L and inhibits RANK-Ls ability to bind with osteoclasts
4 - all of the above

Answer 73

3 - binds with RANK-L and inhibits RANK-Ls ability to bind with osteoclasts

Question 74

Osteoprotegerin is a inhibitory factor released by osteoblasts. Osteoprotegerin binds RANK-L and inhibits its ability to bind with osteoclasts. There are synthetic forms of osteoprotegerin that can have the same effect. Denosumab is the core drug that we need to know that comes under this category. How often and how is this drug administered?

1 - weekly
2 - monthly
3 - 6 monthly
4 - annually

Answer 74

3 - 6 monthly
- given via - subcutaneous injection

Question 75

Osteoprotegerin is a inhibitory factor released by osteoblasts. Osteoprotegerin binds RANK-L and inhibits osteoclasts maturation. There are synthetic forms of osteoprotegerin that can have the same effect, which are classed as RANK-L inhibitors. What is the core drug that we need to know that comes under this category?

1 - bisphosphonate
2 - denosumab
3 - estrogen
4 - triparitide

Answer 75

2 - denosumab
- very expensive

Question 76

What core drug do we need to know that is an anabolic (means to build things) drug that increases bone formation?

1 - bisphosphonate
2 - denosumab
3 - estrogen
4 - triparitide

Answer 76

4 - triparitide

Question 77

Triparitide is a hormone regulator and is the core drug that we need to know that is an anabolic drug that increases bone formation. What is the mechanism of action of this drug?

1 - inhibits PTH
2 - induces constant secretion of PTH
3 - inhibits calcitonin and vitamin D
3 - induces a pulsatile secretion of PTH

PTH = parathyroid hormone

Answer 77

• triparitide is a recombinant analogue of parathyroid hormone (essentially a copy of PTH)
• forms pulses of PTH stimulating both osteoblasts and osteoclasts
• BUT stimulates osteoblast more and increases bone formation

Question 78

Triparitide is a hormone regulator and is the core drug that we need to know that is an anabolic drug that increases bone formation. It is a recombinant analogue of parathyroid hormone (essentially a copy of PTH) that stimulates osteoblasts preferentially over osteoclasts, thus increasing bone formation over bone re-absorption. How often and how is this drug administered?

Answer 78

• administered daily via subcutaneous injection

Question 79

Triparitide is a hormone regulator and is the core drug that we need to know that is an anabolic drug that increases bone formation. It is a recombinant analogue of parathyroid hormone (essentially a copy of PTH) that stimulates osteoblasts preferentially over osteoclasts, thus increasing bone formation over bone re-absorption. What is the key contradiction to Triparitide?

1 - patients with a cancer diagnosis
2 - patients with CVD
3 - patients with active rickets disease
4 - patients who are anaemic

Answer 79

1 - patients with a cancer diagnosis

Question 80

Bone mineral density is the amount of bone contained with a unique area, which can only be quantified using a DEXA scanner. What is the Z score?

1 - score for patients BMD compared to peak of a 30 y/o female
2 - score for patients BMD compared against same gender and age
3 - score for patients BMD compared to peak of a 30 y/o male
4 - score for patients BMD compared against same age

Answer 80

2 - score for patients BMD compared against same gender and age
- z score = patients BMD as a number of SD above or below people of the same gender and age

Question 81

The normal T score generated from a DEXA scan is <1. What is the diagnosis of severe osteoporosis?

1 = -1 to -2.5
2 = < -2.5
3 = < -2.5 with at least one fracture

Answer 81

3 = < -2.5 with at least one fracture

Question 82

The normal T score generated from a DEXA scan is <1. What is the diagnosis of osteoporosis?

1 = -1 to -2.5
2 = < -2.5
3 = < -2.5 with at least one fracture

Answer 82

2 = < -2.5

Question 83

We all have a degree of lordosis (outward curvature of the spine) and kyphosis (inward curvature of the spine) in a normal and healthy spine. Patients with osteoporosis can present with excessive kyphosis. What happens here?

Answer 83

• excessive kyphosis is present in the thoracic region
• results in patients looking like they are bowing of bending over

Question 84

When does the majority of bone mass accumulate?

1 - when baby is a foetus
2 - early childhood
3 - puberty
4 - adulthood

Answer 84

3 - puberty

Question 85

The amino acids contained within protein are important for the matrix of bone. What else is protein important for in bone development?

1 - amino acids are essential for bone matrix
2 - stimulate the release of IGF-1 which stimulates osteoclasts
3 - stimulate the release of IGF-1 which stimulates osteoblasts
4 - stimulate the release of IGF-1 which stimulates osteocytes

IGF-1 = insulin like growth factor

Answer 85

3 - stimulate the release of IGF-1 which stimulates osteoblasts

Question 86

What % of adult women will have a fragility fracture in their lifetime?

1 - 15%
2 - 25%
3 - 50%
4 - 80%

Answer 86

3 - 50%
- 20% in men