OSTEOPOROSIS Flashcards
Which of the following best defines osteoporosis according to the World Health Organization (WHO)?
A. Bone density that is 1.0 standard deviation below the mean for young healthy adults
B. Bone density that is 2.5 standard deviations below the mean for young healthy adults
C. Bone density that falls below the normal range without fracture risk
D. Bone density that leads to fractures only in the presence of severe trauma
Correct Answer: B. Bone density that is 2.5 standard deviations below the mean for young healthy adults
Rationale: The WHO defines osteoporosis as a bone density 2.5 standard deviations (T-score ≤ -2.5) below the mean for young healthy adults of the same sex and race.
A 65-year-old postmenopausal woman with a T-score of -1.8 has no history of fractures. How should her bone health be categorized?
A. Normal
B. Osteoporosis
C. Low bone density (osteopenia)
D. Severe osteoporosis
Correct Answer: C. Low bone density (osteopenia)
Rationale: A T-score between -1.0 and -2.5 is defined as low bone density or osteopenia. This group is at an increased risk for developing osteoporosis and related fractures.
Osteoporosis-related fractures typically occur under which of the following circumstances?
A. High-impact trauma such as a car accident
B. A fall from standing height or lower
C. Repeated stress or overuse
D. Fractures of the skull, fingers, or toes
Correct Answer: B. A fall from standing height or lower
Rationale: Osteoporosis-related fractures are defined as fractures occurring from trauma less than or equal to a fall from standing height, except for fractures of the fingers, toes, face, or skull.
Which of the following is the best approach to identifying osteoporosis-related fracture risk?
A. Measuring bone mineral density alone
B. Estimating 10-year fracture risk using BMD, age, and clinical factors
C. Screening all postmenopausal women regardless of BMD
D. Evaluating trauma history alone
Correct Answer: B. Estimating 10-year fracture risk using BMD, age, and clinical factors
Rationale: The risk of osteoporosis-related fractures is best assessed by combining BMD measurements with clinical factors such as age and gender to calculate a 10-year fracture risk.
Which of the following techniques is considered the gold standard for measuring bone mineral density (BMD)?
A. Single-energy X-ray absorptiometry (SXA)
B. Quantitative computed tomography (CT)
C. Dual-energy X-ray absorptiometry (DXA)
D. Ultrasound
Correct Answer: C. Dual-energy X-ray absorptiometry (DXA)
Rationale: DXA is a highly accurate X-ray technique and is considered the gold standard for measuring bone density. It is commonly used to assess the lumbar spine and hip for clinical determinations of BMD.
What effect do bone spurs in osteoarthritis have on DXA measurements of the spine?
A. They increase the accuracy of the results.
B. They falsely decrease BMD measurements.
C. They falsely increase BMD measurements.
D. They have no impact on BMD measurements.
Correct Answer: C. They falsely increase BMD measurements.
Rationale: Bone spurs, which are common in osteoarthritis, can falsely elevate BMD measurements, especially in the spine, making interpretation more challenging in older individuals.
Which tool is often used alongside DXA to estimate the 10-year risk of major osteoporosis-related fractures?
A. Z-score
B. BMD chart
C. FRAX
D. Serial DXA scans
Correct Answer: C. FRAX
Rationale: The FRAX tool is used to calculate the 10-year fracture risk by incorporating factors such as age, gender, fracture history, hip fracture in a parent, steroid use, and femoral neck BMD.
Why is the hip the preferred site for BMD measurement in most individuals?
A. It is easier to access for DXA scans compared to other sites.
B. It predicts the risk of spinal fractures more accurately.
C. It predicts the risk of hip fractures better than other measurement sites.
D. It is less affected by degenerative changes than the spine.
Correct Answer: C. It predicts the risk of hip fractures better than other measurement sites.
Rationale: The hip is the preferred site for BMD measurement because hip fractures are the most significant consequence of osteoporosis, and the hip measurement predicts this risk more effectively than other sites.
In which group of individuals might spine measurements be more sensitive than hip measurements for detecting bone loss?
A. Older individuals with degenerative spine disease
B. Young adults with a history of fractures
C. Perimenopausal or early postmenopausal women
D. Individuals with severe scoliosis
Correct Answer: C. Perimenopausal or early postmenopausal women
Rationale: Spine measurements are often more sensitive in detecting early bone loss in younger individuals, such as perimenopausal or early postmenopausal women.
What is a common alternative site for BMD measurement when the spine or hip cannot be measured due to conditions like severe degenerative spine disease or scoliosis?
A. Wrist
B. Femur
C. Total body
D. Tibia
Correct Answer: A. Wrist
Rationale: When the spine or hip cannot be measured, the wrist is a common alternative site for BMD measurement, as it can still provide valuable information about bone density.
When performing DXA scans of the hip, what additional measurement is typically performed at the same time?
A. Wrist
B. Spine
C. Femur
D. Total body
Correct Answer: B. Spine
Rationale: When DXA scans are performed to measure the hip, spine measurements are usually taken concurrently to provide a more comprehensive assessment of bone density.
According to the National Osteoporosis Foundation (NOF), at what age should bone mass measurement be considered for all women, regardless of risk factors?
A. 55 years
B. 60 years
C. 65 years
D. 70 years
Correct Answer: C. 65 years
Rationale: The NOF recommends that all women undergo bone mass measurement by age 65, even if they do not have additional risk factors. This guideline is supported by the U.S. Preventive Health Services Task Force.
In men, at what age is bone density measurement recommended in the absence of multiple risk factors or a history of osteoporosis-related fractures?
A. 50 years
B. 60 years
C. 65 years
D. 70 years
Correct Answer: D. 70 years
Rationale: Bone density measurement is not recommended for men until age 70 unless they have multiple risk factors for osteoporosis or a prior osteoporosis-related fracture.
What is the threshold FRAX 10-year risk percentage for major osteoporotic fractures at which treatment is considered cost-effective in the United States?
A. 5%
B. 10%
C. 20%
D. 25%
Correct Answer: C. 20%
Rationale: In the United States, it is considered cost-effective to treat if the 10-year risk for major osteoporotic fractures, as calculated by FRAX, is ≥20%. For hip fractures, the threshold is ≥3%.
Which of the following individuals should undergo BMD testing according to clinical guidelines?
A. A 55-year-old postmenopausal woman with no risk factors
B. A 65-year-old man with no history of fractures or risk factors
C. A 45-year-old woman with rheumatoid arthritis
D. A 40-year-old man without any fractures or risk factors
Correct Answer: C. A 45-year-old woman with rheumatoid arthritis
Rationale:
Indications for Bone Mineral Density Testing * 1. Women aged ≥65 and men aged ≥70; regardless of clinical risk factors
2. Younger postmenopausal women, women in the menopausal transition, and men aged from 50 to 69 with clinical risk factors for fracture
3. Adults who have a fracture at or after age 50
4. Adults with a condition (e.g., rheumatoid arthritis) or taking a medication (e.g., glucocorticoids at a daily dose >5 mg prednisone or equivalent for >3 months associated with low bone mass or bone loss
