Osteoporosis

Question 1

What can be defined as a skeletal disorder characterized by a loss of bone osteoid that reduces bone integrity, resulting in an increased risk of fractures?

Answer 1

osteoporosis

Question 2

In the US osteoporosis causes how many fractures annually?

Answer 2

2 million

Question 3

White women have a __% lifetime risk of sustaining one or more osteoporotic fractures

Answer 3

40

Question 4

What are the 5 most common causes of osteoporosis?

Answer 4

• aging
• high-dose corticosteroid administration
• alcoholism
• smoking
• sex hormone deficiency

Question 5

What is the most common cause of osteoporosis in men?

Answer 5

antiandrogen therapy for prostate conacer

Question 6

What is caused by a major mutation in the gene coding for type I collagen (bone constitute)?

Answer 6

osteogenesis imperfecta

Question 7

When does osteoporosis become symptomatic?

Answer 7

following fracture

Question 8

Are serum calcium, phosphate, and PTH normal, decreased, or increased?

Answer 8

normal

Question 9

Are vitamin levels D normal, decreased, or increased?

Answer 9

decreased

Question 10

Serum 25-hydroxyvitamin D levels < __g/mL are considered frank vitamin D deficiency

Answer 10

20

Question 11

A T-score greater than or equal to __ is considered normal

Answer 11

-1.0

Question 12

A T-score between __ - __ is considered osteopenia (low bone density)

Answer 12

-1.0 to -2.5

Question 13

A T-score less than __ is considered osteoporosis

Answer 13

-2.5

Question 14

Fracture risks increase __-fold for each standard deviation drop in bone mineral density

Answer 14

two

Question 15

DXA should be obtained every _ years for T scores -1.0 to -1.5

Answer 15

5

Question 16

DXA should be obtained every _ years for T scores -1.5 to -2.0

Answer 16

3-5

Question 17

DXA should be obtained every _ years for T scores less than -2.0

Answer 17

1-2

Question 18

The “_ score” is a statistical term that is used for expressing an individual’s bone density as standard deviation from age-matched, race-matched, and sex-matched means

Answer 18

Z

Question 19

What are 2 differential diagnoses of osteoporosis?

Answer 19

• osteomalacia

- bone marrow neoplasm

Question 20

Diet should be high in what 4 things when treating osteoporosis?

Answer 20

• protein
• total calories
• calcium
• vitamin D

Question 21

What are the 7 specific treatment measures?

Answer 21

1) vitamin D and calcium
2) biphosphonates
3) sex hormones
4) selective estrogen receptor modulators
5) teriparatide
6) calcitonin
7) denosumab

Question 22

True or False

Sun exposure and vitamin D supplementation are useful in preventing and treating osteoporosis

Answer 22

False

Question 23

Vitamin D supplementation reduces the incidence of vertebral fractures by __%

Answer 23

37

Question 24

Calcium supplementation does not reduce the risk of fracture in those with dietary calcium intake over ____ mg daily

Answer 24

1000

Question 25

Calcium supplementation may be linked to an increase in what?

Answer 25

myocardial infarction

Question 26

How do biphosphonates help treat osteoporosis?

Answer 26

They increase bone density significantly and reduce the incidence of both vertebral and nonvertebral fractures

Question 27

Biphosphonates are effective in preventing what?

Answer 27

corticosteroid-induced osteoporosis

Question 28

To ensure intestinal absorption when should oral bisphosphonates by taken?

Answer 28

in the morning with at least 8 oz of water 40 minutes before consuming anything else

Question 29

What are 3 oral bisphosphonates?

Answer 29

- alendronate - risedronate - ibandronate

Question 30

What are 2 IV bisphosphonates?

Answer 30

- zoledronic acid | - pamidronate

Question 31

Bisphosphonate therapy can cause several side effects that are collectively known as what?

Answer 31

the acute-phase response

Question 32

What are the symptoms of the acute-phase response?

Answer 32

- fever, chills, or flushing - musculoskeletal pain - nausea, vomiting, or diarrhea - fatigue or dyspnea - edema - headache or dizziness - eye inflammation

Question 33

The acute-phase response typically develops after treatment with what?

Answer 33

their first infusion of zoledronic acid

Question 34

Bisphosphonate use for more than 5 years is associated with what?

Answer 34

An increased risk in subtrochanteric or femoral shaft fractures

Question 35

Patients taking oral bisphosphonates have an increased risk of developing what?

Answer 35

esophageal cancer

Question 36

Bisphosphonates can e discontinued after a _ year course of therapy. Why?

Answer 36

5 Because they have a half life of 10 years in bone

Question 37

What is essential in preventing osteoporosis in postmenopausal women?

Answer 37

estrogen replacement therapy (ERT)

Question 38

What can help prevent osteoporosis in hypogonadal men?

Answer 38

testosterone administration

Question 39

What can be used in place of estrogen for prevention of osteoporosis?

Answer 39

Raloxifene (a selective estrogen receptor modulator)

Question 40

What is the advantage of taking raloxifene over estrogen supplements?

Answer 40

Reduced risk of breast cancer

Question 41

However, raloxifene can increase the risk for what?

Answer 41

thromboembolism

Question 42

Teriparatide is an analog of what hormone?

Answer 42

parathyroid hormone

Question 43

What does teriparatide do?

Answer 43

It stimulates the production of new collagenous bone matrix that must be mineralized

Question 44

Teriparatide dramatically increases the bone density in all bones except for which one?

Answer 44

the distal radius

Question 45

What patients are contraindicated for teriparatide use?

Answer 45

- patients with hypercalcemia ** | - those with an increased risk of osteosarcoma (Paget's disease, open epiphyses, past history)

Question 46

What should be considered following a course of teriparatide and why?

Answer 46

A course of bisphosphonates in order to retain the improved bone density

Question 47

Both nasal and parenteral _____ have analgesic effects on bone pain from fractures and have shown to reduce the risk factor of vertebral fractures

Answer 47

calcitonin

Question 48

______ is a monoclonal antibody that inhibits the proliferation and maturation of preosteoclasts into mature osteoclast bone-resorbing cells

Answer 48

Denosumab

Question 49

How does denosumab function?

Answer 49

It binds to the osteoclast receptor activator of nuclear factor-kappa B ligand (RANKL)

Question 50

Denosumab should not used in patients with ___calcemia

Answer 50

hypo